A case of selective arterial embolization for recurrent hemarthrosis after total knee arthroplasty

Abstract

Hemarthrosis after total knee arthroplasty is rare, with a reported frequency of 0.3–1.6% [1–4]. Treatment methods include conservative therapy by arthrocentesis, immobilizing the joint in a cast or brace, and discontinuation of anticoagulants. In cases of repeated hemarthrosis, however, surgery is indicated. Surgical procedures comprise open or arthroscopic synovectomy. Open synovectomy ensures reliable hemostasis but is highly invasive. Arthroscopic synovectomy is less invasive but may result in the recurrence of hemarthrosis. Some reports have noted that identifying the site of hemorrhage is not always possible in either procedure [1]. We performed selective angiography and arterial embolization on a patient with recurrent hemarthrosis 10 years after total knee arthroplasty and were able to definitively identify the site of hemorrhage and perform hemostasis. Knee pain and swelling improved from the day after the operation, and the patient became ambulatory. The patient has experienced no recurrence of hemarthrosis since embolization. Case report