Treatment of Recurrent Hemarthrosis after Total Knee Arthroplasty

Abstract

Purpose: The purpose of this study is to evaluate the incidence and treatment of recurrent hemarthrosis after total knee replacement (TKR).

Materials and methods: Among a total of 5,510 patients who underwent TKR from March 2000 to October 2016, patients who had two or more bleeding 2 weeks after surgery were studied. Conservative treatments were performed for all cases with symptoms. In patients who did not respond to conservative treatment several times, embolization was performed. We retrospectively evaluated the postoperative bleeding time, bleeding frequency, treatment method, and outcome.

Results: Seventeen (0.3%) of the 5,510 patients developed recurrent hemarthrosis. Bleeding occurred at an average of 2 years 3 months after the operation. Joint aspiration was performed 3.5 times (range, 2 to 10 times) on average, and 14 cases (82.3%) were treated with conservative treatment. In 3 patients with severe bleeding and hemorrhage, embolization was performed.

Conclusions: Recurrent hemarthrosis after TKR is a rare disease with a low incidence of 0.3% and usually could be treated by conservative treatment. If recurrences occur repeatedly, embolization through angiography or surgical treatment may be considered, but the results are not satisfactory and careful selection of treatment modalities is warranted.

Keywords: Arthroplasty; Embolization; Hemarthrosis; Knee.

Fig. 1

(A) Interventional angiography was performed in the left lower limb in a 67-year-old woman with recurrent hemarthrosis. (B) In angiography, a vascular blush was observed in the left superior lateral geniculate artery. (C) Successful embolization was done using 1:4 mixture of glue and lipiodol for the left superior lateral geniculate artery (arrow). However, bleeding from the inferior lateral geniculate artery (arrow head) was neglected.

Fig. 2

(A) Interventional angiography was performed in the right lower limb in a 69-year-old woman with recurrent hemarthrosis. (B) In angiography, a vascular blush was observed in the right superior and inferior lateral geniculate arteries and descending geniculate artery. (C) Gelfoam embolization was performed for the right superior and inferior lateral geniculate arteries and descending geniculate artery (arrows).