Successful Selective Embolization for Recurrent Hemarthrosis after Knee Arthroplasty

Area of Science:

• Orthopedics
• Vascular Surgery
• Radiology

Background:

• Total knee arthroplasty is a cost-effective treatment for severe knee osteoarthritis.
• Perioperative complications, such as recurrent hemarthrosis (0.3-1.6% incidence), can occur after knee replacement.
• Conservative treatment for hemarthrosis has an 80% success rate, but recurrence necessitates further intervention.

Observation:

• A patient presented with medial knee pain seven months post-total knee arthroplasty.
• Infection was excluded, and arthrocentesis confirmed hemarthrosis.
• Diagnostic imaging (CTA/MRA/Doppler US) is used for recurrent bleeding, with arthroscopy or embolization as treatment options.

Findings:

• Selective embolization of the medial superior and lateral superior genicular arteries was successfully performed.
• The patient reported significant improvement in joint function and pain scores two years post-embolization.
• High scores on the Forgotten Joint Score (92) and low WOMAC scores (pain 0, stiffness 1, function 3) indicate successful management.

Implications:

• Selective arterial embolization is a viable and effective treatment for post-arthroplasty recurrent hemarthrosis.
• Minimally invasive embolization can lead to excellent long-term functional recovery and patient satisfaction.
• This approach avoids open surgery in most cases of persistent bleeding after knee replacement.