3:00 PMAbstract No. 326 - Selective geniculate artery embolization for management of recurrent hemarthrosis after knee arthroplasty

Abstract

PurposeSpontaneous recurrent hemarthrosis occurs in up to 1.6% of patients following total knee arthroplasty, most often related to hypervascular proliferative synovium and associated component impingement, making the synovium prone to trauma and bleeding. Hemarthrosis may result in poor arthroplasty function or failure. When conservative management fails, targeted geniculate artery embolization (GAE) can serve as a treatment alternative to synovectomy. We present a single institutional experience with GAE for recurrent hemarthrosis in the setting of prior knee arthroplasty.MaterialsAll GAE performed in patients with clinical and/or imaging findings of recurrent hemarthrosis post knee arthroplasty between July 2003 and September 2015 were included in this study. Iatrogenic pseudoaneurysms were excluded. Patient demographics, embolic agent, technical success, procedure time, and immediate complications were ascertained. Imaging and clinical follow-up data was reviewed.Results46 GAE performed in 35 patients (17 male, 18 female; mean age 67, range 41-83 years) met inclusion criteria. Intraprocedural angiography demonstrated focal synovial hyperemia in 100% of cases. Embosphere particles were used in all but one case where microcoils were used. Particle size ranged from 100-700 um, 93% of cases utilizing solely 100-300 um particles. Embolization was technically successful in all cases. Postembolization angiograms demonstrated diminished or absent synovial hypervascularity in all cases. Periprocedural transient cutaneous ischemia occurred in 11%. Postprocedural follow-up was available for 25 cases with a mean follow-up interval of 70 days (range 1-413 days), with 23 (92%) exhibiting clinical improvement of symptoms. 11 repeat GAEs were performed in 9 patients experiencing recurrence or persistence of symptoms. Of these, review of initial post GAE angiogram revealed residual synovial blush in 10 (91%).ConclusionsTargeted GAE with spherical particles is an effective treatment for recurrent hemarthrosis following knee replacement with low immediate complication rates. Residual focal hyperemia on immediate postembolization angiogram may be associated with clinical recurrence or persistence.