Predictive Variables for Interventional Angiography Among Patients with Knee Hemarthrosis

Overview

Journal Diagnostics (Basel)

Specialty Radiology

Date 2022 Apr 23

PMID 35454024

Authors

Sang-Hun Ko

Kwang-Hwan Jung

Jae-Ryong Cha

Ki-Bong Park

Affiliations

Soon will be listed here.

Abstract

Studies regarding the variables that could predict the success of conservative treatment for knee hemarthrosis are lacking. This retrospective study evaluated the laboratory variables of patients who had unsatisfactory results from conservative treatment for knee hemarthrosis. Twenty-nine patients conservatively treated for knee hemarthrosis were included and divided into two groups: group A comprised 14 patients who underwent interventional angiography and selective embolization due to failed conservative treatment, and group B comprised 15 patients with successful results after conservative treatment. The results of the serological and synovial fluid tests were evaluated. The mean number of synovial red blood cells (RBCs) was 1,905,857 cells/µL and 7730 cells/µL in groups A and B, respectively (p = 0.01), while the mean number of RBCs per high-power field (HPF) was 68.9 and 3.2, respectively (p < 0.01). Patients who underwent interventional angiography and selective embolization after failed conservative treatment for knee hemarthrosis had higher synovial RBC counts and RBC counts per HPF than those with successful outcomes after conservative treatment. It is necessary to carefully interpret the results of the synovial fluid analysis in patients with knee hemarthrosis; if the synovial fluid analysis shows a synovial RBC count greater than 81,500 and RBC count per HPF greater than 16.3, we recommend immediate interventional angiography rather than continuing conservative treatment.

References

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

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

Katsimihas M, Robinson D, Thornton M, Langkamer V . Therapeutic embolization of the genicular arteries for recurrent hemarthrosis after total knee arthroplasty. J Arthroplasty. 2001; 16(7):935-7. DOI: 10.1054/arth.2001.25555. 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

Olsson O, Isacsson A, Englund M, Frobell R . Epidemiology of intra- and peri-articular structural injuries in traumatic knee joint hemarthrosis - data from 1145 consecutive knees with subacute MRI. Osteoarthritis Cartilage. 2016; 24(11):1890-1897. DOI: 10.1016/j.joca.2016.06.006. View

Hernandez N, Taunton M, Perry K, Mara K, Hanssen A, Abdel M . The analysis of synovial fluid in total knee arthroplasties with flexion instability. Bone Joint J. 2017; 99-B(11):1477-1481. DOI: 10.1302/0301-620X.99B11.BJJ-2017-0195.R2. View

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

Aldin Z, Obaid H, Abdelsalam H, Bolia A . Case report: Spontaneous recurrent idiopathic knee haemarthrosis in a paediatric patient: successful transcatheter embolization. Clin Radiol. 2010; 65(1):82-4. DOI: 10.1016/j.crad.2009.07.016. View

Brown J, Frobell R, Isacsson A, Englund M, Olsson O . Agreement Between Clinical Examination and Magnetic Resonance Imaging in Acute Knee Trauma With Hemarthrosis. Clin J Sport Med. 2021; 32(4):401-406. DOI: 10.1097/JSM.0000000000000950. View

10.

Pow R, Fritsch B, Waugh R, Rogan C . Endovascular management of recurrent hemarthrosis of the knee: a case series. CVIR Endovasc. 2020; 3(1):43. PMC: 7456626. DOI: 10.1186/s42155-020-00135-0. View

11.

Given M, Smith P, Lyon S, Robertson D, Thomson K . Embolization of spontaneous hemarthrosis post total knee replacement. Cardiovasc Intervent Radiol. 2008; 31(5):986-8. DOI: 10.1007/s00270-007-9257-5. View

12.

Lim H, Song E, Seon J, Park K, Shin Y, Yang H . Causes of Aseptic Persistent Pain after Total Knee Arthroplasty. Clin Orthop Surg. 2017; 9(1):50-56. PMC: 5334027. DOI: 10.4055/cios.2017.9.1.50. View

13.

Ghanem E, Parvizi J, Burnett R, Sharkey P, Keshavarzi N, Aggarwal A . Cell count and differential of aspirated fluid in the diagnosis of infection at the site of total knee arthroplasty. J Bone Joint Surg Am. 2008; 90(8):1637-43. DOI: 10.2106/JBJS.G.00470. View

14.

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

15.

Park K, Kim D, Jang S, Ryu J, Ko K . Treatment of Recurrent Hemarthrosis Following Total Knee Arthroplasty Using Surgical Interventions. Clin Orthop Surg. 2021; 13(2):152-159. PMC: 8173232. DOI: 10.4055/cios20066. View

16.

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

17.

Shaerf D, Banerjee A . Assessment and management of posttraumatic haemarthrosis of the knee. Br J Hosp Med (Lond). 2008; 69(8):459-60, 462-3. DOI: 10.12968/hmed.2008.69.8.30743. View

18.

Matsuzaki T, Akisue T, Kishimoto K, Kishimoto S, Imabori M, Hara H . Intra-articular nodular fasciitis of the knee: a rare cause of recurrent hemarthrosis. Rheumatol Int. 2011; 32(6):1691-4. DOI: 10.1007/s00296-011-1861-7. View

19.

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

20.

Karataglis D, Marlow D, Learmonth D . Atraumatic haemarthrosis following total knee replacement treated with selective embolisation. Acta Orthop Belg. 2006; 72(3):375-7. View