Abstract
BackgroundRecurrent hemarthrosis of the knee is an uncommon but potentially debilitating occurrence with multiple etiologies, including previous total knee replacement. The purpose of this study is to present data of a group of patients undergoing angiography and embolization for recurrent hemarthrosis of the knee. Patient characteristics, angiographic findings, safety and efficacy of the procedure are reported.MethodsA retrospective single centre review of patients undergoing angiography and embolization at a tertiary referral centre in Sydney, Australia from March 2006 to April 2018 was performed. A total of 25 patients undergoing a total of 29 procedures were identified (20 female, 5 male; mean age 67), the majority of which (23/25, 92%) had a history of total knee arthroplasty. Embolization was performed in 28 of the 29 procedures (97%). The embolic agent used was either polyvinyl alcohol particles (23/28), gelatin foam (3/28), detachable microcoils (1/28) or a combination of particles and coils (1/28).ResultsThe most commonly identified dominant vascular abnormality was periarticular synovial hypervascularity (23/25, 92%). A pseudoaneurysm was demonstrated in two patients (8%). Technical success (elimination of angiographic abnormalities) was achieved in 27 of 29 procedures (93%). There were 6 episodes of recurrence (25%) following a single embolization procedure, three of which were managed successfully with repeat embolization. There were no complications relating to skin or periarticular ischemia.ConclusionAngiography and embolization is a safe and effective tool for the management of recurrent hemarthrosis of the knee following arthroplasty and should be considered first line treatment following failure of conservative management.Level of evidenceLevel 4, Case Series.
Highlights
Recurrent hemarthrosis of the knee is an uncommon but potentially debilitating occurrence with multiple etiologies, including previous total knee replacement
In the setting of previous total knee arthroplasty (TKA), it occurs with a frequency of 0.3–1.6% (Bagla et al 2013; Saksena et al 2010), where it is associated with recurrent pain, joint-stiffness and poor postoperative recovery (Yoo et al 2018)
Angiographic findings and embolization The dominant angiographic finding in 92% (23/25) of patients was that of increased vascularity about the knee joint with or without hypertrophy of the dominant feeding vessels
Summary
Recurrent hemarthrosis of the knee is an uncommon but potentially debilitating occurrence with multiple etiologies, including previous total knee replacement. In the setting of previous total knee arthroplasty (TKA), it occurs with a frequency of 0.3–1.6% (Bagla et al 2013; Saksena et al 2010), where it is associated with recurrent pain, joint-stiffness and poor postoperative recovery (Yoo et al 2018). In this patient group, recurrent hemarthrosis is thought to most commonly relate to hypertrophy of vascular synovium and entrapment of Diagnosis is predominantly based on a combination of clinical symptoms and joint aspiration (Yoo et al 2018). Rates of technical success with embolization are reported at 99–100% with clinical success rates of 80–93% (Kolber et al 2016; Dhondt et al 2009; van Baardewijk et al 2019; Waldenberger et al 2012; Guevara et al 2018)
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