Endovascular Management of Recurrent Hemarthrosis of the Knee: a Case Series

Overview

Journal CVIR Endovasc

Date 2020 Sep 1

PMID 32864716

Citations 2

Authors

Richard Pow

Brett Fritsch

Richard Waugh

Chris Rogan

Affiliations

Soon will be listed here.

Abstract

Background: Recurrent 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.

Methods: A 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).

Results: The 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.

Conclusion: Angiography 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 Evidence: Level 4, Case Series.

Citing Articles

Treating recurrent hemarthrosis after knee arthroplasty with selective embolization: a cohort study of 56 patients.

Sirola S, Heikkinen J, Kerimaa P, Kariniemi J, Niinimaki T Acta Orthop. 2025; 96():33-37.

PMID: 39786206 PMC: 11714783. DOI: 10.2340/17453674.2024.42660.

Musculoskeletal Embolotherapy.

Barge T, Little M Cardiovasc Intervent Radiol. 2022; 46(11):1517-1524.

PMID: 36352126 DOI: 10.1007/s00270-022-03302-z.

Predictive Variables for Interventional Angiography among Patients with Knee Hemarthrosis.

Ko S, Jung K, Cha J, Park K Diagnostics (Basel). 2022; 12(4).

PMID: 35454024 PMC: 9025792. DOI: 10.3390/diagnostics12040976.

References

Pham T, Bouloudian S, Moreau P, Mofid R, Garcier J, Boyer L . Recurrent hemarthrosis following total knee arthroplasty. Report of a case treated with arterial embolization. Joint Bone Spine. 2003; 70(1):58-60. DOI: 10.1016/s1297-319x(02)00012-x. View

Kolber M, Shukla P, Kumar A, Zybulewski A, Markowitz T, Silberzweig J . Endovascular Management of Recurrent Spontaneous Hemarthrosis After Arthroplasty. Cardiovasc Intervent Radiol. 2016; 40(2):216-222. DOI: 10.1007/s00270-016-1511-2. View

Okuno Y, Korchi A, Shinjo T, Kato S . Transcatheter arterial embolization as a treatment for medial knee pain in patients with mild to moderate osteoarthritis. Cardiovasc Intervent Radiol. 2014; 38(2):336-43. DOI: 10.1007/s00270-014-0944-8. View

van Baardewijk L, Hoogeveen Y, van der Geest I, Schultze Kool L . Embolization of the Geniculate Arteries Is an Effective Treatment of Recurrent Hemarthrosis Following Total Knee Arthroplasty That Can Be Safely Repeated. J Arthroplasty. 2017; 33(4):1177-1180.e1. DOI: 10.1016/j.arth.2017.11.002. View

Worland R, Jessup D . Recurrent hemarthrosis after total knee arthroplasty. J Arthroplasty. 1996; 11(8):977-8. DOI: 10.1016/s0883-5403(96)80144-6. View

Rukavina A, Kerkhoffs G, Schneider P, Kuster M . Recurrent hemarthrosis after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2010; 18(7):898-900. PMC: 2887507. DOI: 10.1007/s00167-009-1031-6. View

Dhondt E, Vanhoenacker F, D Archambeau O, Snoeckx A, Defreyne L . Angiographic findings and therapeutic embolization of late hemarthrosis after total joint arthroplasty. Skeletal Radiol. 2008; 38(1):31-6. DOI: 10.1007/s00256-008-0569-6. View

Bagla S, Rholl K, van Breda A, Sterling K, van Breda A . Geniculate artery embolization in the management of spontaneous recurrent hemarthrosis of the knee: case series. J Vasc Interv Radiol. 2013; 24(3):439-42. DOI: 10.1016/j.jvir.2012.11.011. View

Ohdera T, Tokunaga M, Hiroshima S, Yoshimoto E, Matsuda S . Recurrent hemarthrosis after knee joint arthroplasty: etiology and treatment. J Arthroplasty. 2004; 19(2):157-61. DOI: 10.1016/j.arth.2003.09.009. View

10.

Waldenberger P, Chemelli A, Hennerbichler A, Wick M, Freund M, Jaschke W . Transarterial embolization for the management of hemarthrosis of the knee. Eur J Radiol. 2011; 81(10):2737-40. DOI: 10.1016/j.ejrad.2011.11.016. View

11.

Kindsfater K, Scott R . Recurrent hemarthrosis after total knee arthroplasty. J Arthroplasty. 1995; 10 Suppl:S52-5. DOI: 10.1016/s0883-5403(05)80231-1. View

12.

Sheth R, Sabir S, Krishnamurthy S, Avery R, Zhang Y, Khademhosseini A . Endovascular Embolization by Transcatheter Delivery of Particles: Past, Present, and Future. J Funct Biomater. 2017; 8(2). PMC: 5491993. DOI: 10.3390/jfb8020012. View

13.

Yamagami T, Yoshimatsu R, Miura H, Arai Y, Terauchi R, Nakagawa S . Selective arterial embolization with gelatin particles for refractory knee hemarthrosis. Diagn Interv Radiol. 2013; 19(5):423-6. DOI: 10.5152/dir.2013.13063. View

14.

Yoo J, Oh H, Park S, Lee S, Lee Y, Kim S . Treatment of Recurrent Hemarthrosis after Total Knee Arthroplasty. Knee Surg Relat Res. 2018; 30(2):147-152. PMC: 5990227. DOI: 10.5792/ksrr.17.059. View

15.

Khoury N, Champagne P, Kotowski M, Raymond J, Roy D, Weill A . Unexpected complications with head and neck hydrogel microsphere particle embolization: A case series and a technical note. Interv Neuroradiol. 2016; 23(1):107-111. PMC: 5305148. DOI: 10.1177/1591019916668840. View

16.

Koh S, Maki E, Kolbeck K, Farsad K . Skin ischemia and ulceration as a complication of inferior phrenic artery embolization for hepatocellular carcinoma. Radiol Case Rep. 2018; 13(3):648-651. PMC: 6053693. DOI: 10.1016/j.radcr.2018.02.032. View

17.

Filippiadis D, Binkert C, Pellerin O, Hoffmann R, Krajina A, Pereira P . Cirse Quality Assurance Document and Standards for Classification of Complications: The Cirse Classification System. Cardiovasc Intervent Radiol. 2017; 40(8):1141-1146. DOI: 10.1007/s00270-017-1703-4. View

18.

Saksena J, Platts A, Dowd G . Recurrent haemarthrosis following total knee replacement. Knee. 2009; 17(1):7-14. DOI: 10.1016/j.knee.2009.06.008. View

19.

Bagla S, Piechowiak R, Hartman T, Orlando J, Del Gaizo D, Isaacson A . Genicular Artery Embolization for the Treatment of Knee Pain Secondary to Osteoarthritis. J Vasc Interv Radiol. 2019; 31(7):1096-1102. DOI: 10.1016/j.jvir.2019.09.018. View

20.

Guevara C, Lee K, Barrack R, Darcy M . Technically Successful Geniculate Artery Embolization Does Not Equate Clinical Success for Treatment of Recurrent Knee Hemarthrosis after Knee Surgery. J Vasc Interv Radiol. 2016; 27(3):383-7. DOI: 10.1016/j.jvir.2015.11.056. View