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Nicolino TI, Costantini J, Astore I, Yacuzzi CH, Astoul Bonorino J, Costa Paz M, Carbó L. Incidence of vascular injury associated with knee arthroplasty: series of cases. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024:10.1007/s00590-023-03814-5. [PMID: 38252291 DOI: 10.1007/s00590-023-03814-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 12/15/2023] [Indexed: 01/23/2024]
Abstract
INTRODUCTION The incidence of vascular injury associated with knee arthroplasty is scarce, but, when they occur, the consequences are serious. OBJECTIVES Describe the incidence of vascular lesions in our center and evaluate time to diagnosis, resolution and follow-up. MATERIALS AND METHODS Retrospective cohort during the 2010-2019 period of primary arthroplasties and knee revision. The incidence of vascular lesions and their demographic characteristics were analyzed. Type of lesion, diagnostic method and treatment were recorded. It was evaluated in distant follow-up of pain and functionality. RESULTS 7.940 primary total knee arthroplasty and revision surgeries were recorded, and a report of 7 emergency cases for vascular lesions was also recorded, with an incidence of 0.088%. 3 vascular lesions were caused by direct laceration of the popliteal artery, 1 case of thrombosis of the popliteal artery and 3 cases of pseudoaneurysmal lesion of the superior genicular artery. Three vascular lesions that occurred in primary arthroplasty were immediately repaired by a vascular surgeon. Pseudoaneurysm lesions and thrombosis were resolved by angiographic procedure. DISCUSSION Vascular complications around the knee are rare. Time to diagnosis and treatment is essential. Digital angiography is a diagnostic and therapeutic tool. There are various repair techniques, whether it's embolization, cauterization, stenting or endoprosthesis; therefore, digital angiography is a safe method with a low complication rate. CONCLUSION The incidence of vascular lesions in knee arthroplasty in our center is very low. The cases were diagnosed and resolved early, without registering subsequent complications with good functional results in distant follow-up.
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Affiliation(s)
- T I Nicolino
- Arthroscopy and Knee Prosthesis Sector, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
- Arthroscopy and Knee Prosthesis Sector, Italian Hospital of San Justo, Buenos Aires, Argentina
| | - J Costantini
- Arthroscopy and Knee Prosthesis Sector, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - I Astore
- Arthroscopy and Knee Prosthesis Sector, Italian Hospital of Buenos Aires, Buenos Aires, Argentina.
| | - Carlos H Yacuzzi
- Arthroscopy and Knee Prosthesis Sector, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - J Astoul Bonorino
- Arthroscopy and Knee Prosthesis Sector, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
- Arthroscopy and Knee Prosthesis Sector, Italian Hospital of San Justo, Buenos Aires, Argentina
| | - M Costa Paz
- Arthroscopy and Knee Prosthesis Sector, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - L Carbó
- Arthroscopy and Knee Prosthesis Sector, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
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Puijk R, Rassir R, Kaufmann LW, Nolte PA. A Pseudoaneurysm of the Inferior Lateral Geniculate Artery Following Total Knee Arthroplasty. Arthroplast Today 2022; 15:120-124. [PMID: 35514363 PMCID: PMC9062352 DOI: 10.1016/j.artd.2022.03.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 03/15/2022] [Accepted: 03/16/2022] [Indexed: 12/04/2022] Open
Abstract
Vascular complications after total knee arthroplasty are rare. We present a case of an inferior lateral geniculate artery pseudoaneurysm which became symptomatic 10 days after total knee arthroplasty in a patient with a cardiac comorbidity and using dabigatran. The pseudoaneurysm was most likely caused by iatrogenic injury during surgery. Fourteen days after the index surgery, the patient was seen with a painful but normal post-total knee arthroplasty effused knee, with a maximum flexion angle of 80 degrees. No signs of infection, hemarthrosis, or neurovascular deficit were present. Radiographic imaging included ultrasonography and computed tomography angiography. The pseudoaneurysm was successfully treated with coil embolization. The etiology, presentation, diagnosis, and treatment of a geniculate artery pseudoaneurysm are discussed in this case report.
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Affiliation(s)
- Raymond Puijk
- Department of Orthopaedic Surgery, Spaarne Gasthuis, Hoofddorp, the Netherlands
- Corresponding author. Department of Orthopaedic Surgery, Spaarne Gasthuis, Spaarnepoort 1, 2134 TM, Hoofddorp, the Netherlands.
| | - Rachid Rassir
- Department of Orthopaedic Surgery, Spaarne Gasthuis, Hoofddorp, the Netherlands
| | - Lars W. Kaufmann
- Department of Radiology, Spaarne Gasthuis, Hoofddorp, the Netherlands
| | - Peter A. Nolte
- Department of Orthopaedic Surgery, Spaarne Gasthuis, Hoofddorp, the Netherlands
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Sundaram K, Arnold NR, Mont MA, Sodhi N, Warren J, Kamath AF, Piuzzi NS. Selective Embolization Is Safe and Effective for Total Knee Arthroplasty-Associated Recurrent Hemarthroses: A Systematic Review and Meta-Analysis. J Knee Surg 2021; 34:877-885. [PMID: 31891962 DOI: 10.1055/s-0039-3402482] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Total knee arthroplasty (TKA)-associated hemarthroses are infrequent and often respond to nonoperative therapy. Geniculate artery embolization may provide symptomatic relief in cases recalcitrant to needle aspiration, although no meta-analysis exists regarding this therapy. This meta-analysis aims to assess the rate of symptom relief, the number of embolizations needed to achieve relief, and the rate of complications associated with embolization. Public databases were queried from 1998 until 2018 for TKA-associated recurrent hemarthroses treated with embolization. Eight studies met inclusion and exclusion criteria. Major complications were defined as those requiring readmission or nonelective reoperation; minor complications were defined as those not requiring readmission or reoperation. Pooled statistics were calculated utilizing the method of inverse variance. Fifty-nine patients with a mean follow-up of 30 months (range, 1-50 months) were evaluated. The pooled proportion of patients with symptom improvement following embolization was 86% (95% confidence interval [CI]: 74-93%, I 2: 0%, p = 0.97). The average number of embolization procedures was 1.30 (95% CI: 1.03-1.63, I 2: 0%, p = 0.66). The pooled proportion of patients who required a second embolization procedure was 26% (95% CI: 15-40%, I 2: 0%, p = 0.43), while those requiring three or more procedures was 13% (95% CI: 6-25%, I 2: 0%, p = 0.87). The rate of complications were as follows: any complication - 19% (95% CI: 11-32%, I 2: 0%, p = 0.81); major complications-8% (95% CI: 3-19%, I 2: 0%, p = 0.96); minor complications-18% (95% CI: 10-31%, I 2: 0%, p = 0.79); inguinal hematoma-9% (95% CI: 4-19%, I 2: 0%, p = 1.00); skin necrosis-15% (95% CI: 7-29%, I 2: 0%, p = 0.62); and incision breakdown-7% (95% CI: 3-17%, I 2: 0%, p = 1.00). Previous literature on selective artery embolization following TKA is relatively limited. This meta-analysis supports embolization as a potentially safe and effective treatment for recurrent hemarthroses after TKA. Other correctable causes of recurrent hemarthrosis, such as instability or malalignment, must be diligently ruled out prior to utilizing embolization. Surgeons should be aware of embolization's potential role in the postoperative period following TKA.
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Affiliation(s)
- Kavin Sundaram
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Nicholas R Arnold
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Michael A Mont
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Nipun Sodhi
- Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, New York
| | - Jared Warren
- Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, New York
| | - Atul F Kamath
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Nicolas S Piuzzi
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
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Park KH, Kim DH, Jang SW, Ryu JH, Ko KY. Treatment of Recurrent Hemarthrosis Following Total Knee Arthroplasty Using Surgical Interventions. Clin Orthop Surg 2021; 13:152-159. [PMID: 34094005 PMCID: PMC8173232 DOI: 10.4055/cios20066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/01/2020] [Accepted: 07/07/2020] [Indexed: 11/07/2022] Open
Abstract
Backgroud Recurrent hemarthrosis following total knee arthroplasty (TKA) is a rare complication. Its pathophysiology and standard treatments have not yet been established. In this study, we report 7 cases of recurrent hemarthrosis after TKA in which failure of the initial conservative treatment was followed by angiographic embolization; in 1 of the 7 cases, arthroscopic electrocauterization was also performed after treatment failure with selective embolization. Methods From January 2015 to May 2018, 7 patients visited our hospital due to recurrent hemarthrosis after TKA. Their medical records and serologic test results were reviewed to check for the presence of any bleeding disorder and history of anticoagulant use. Implant malalignment and instability were checked using X-ray. In all cases, the conservative treatment failed, so interventional angiography with selective embolization was performed, which was also followed by arthroscopic electrocauterization if the outcome was unsatisfactory. Results The interval between TKA and the onset of hemarthrosis ranged from 3 to 76 months (average, 34.1 months). There was no coagulopathy and instability. All patients underwent conservative treatment at an interval of 4.3 months and the rate of relapse was 3.1 on average. On the interventional angiography, 6 cases showed vascular blush, and 1 case had pulsatile bleeding. The average duration for interventional angiography was 90.9 minutes. The average length of follow-up was 38.8 months. Embolization was successfully performed in 4 cases. In 2 of 3 failed cases, the symptoms improved without further treatment. In the remaining 1 failed case, the patient had a relapse of hemarthrosis, so an arthroscopic procedure was performed, which led to identification of the suspicious bleeding point by using preoperative angiographic findings. Electrocauterization was performed and active bleeding was stopped. All cases with recurrent hemarthrosis achieved improvement. Conclusions Interventional angiography was used to aid in the diagnosis of recurrent hemarthrosis, and therapeutic selective embolization provided satisfactory clinical results. Even if selective embolization fails, interventional angiography may be helpful for further surgical procedures because it reveals vascular blush of a bleeding site. Therefore, interventional angiography and selective embolization should be considered to be a useful treatment for recurrent hemarthrosis after TKA.
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Affiliation(s)
- Keun Ho Park
- Division of Cardiology, Department of Internal Medicine, Chosun University College of Medicine, Gwangju, Korea
| | - Dong Hwi Kim
- Department of Orthopaedic Surgery, Chosun University College of Medicine, Gwangju, Korea
| | - Se Woong Jang
- Department of Orthopaedic Surgery, Chosun University College of Medicine, Gwangju, Korea
| | - Je Hong Ryu
- Department of Orthopaedic Surgery, Chosun University College of Medicine, Gwangju, Korea
| | - Kang Yeol Ko
- Department of Orthopaedic Surgery, Chosun University College of Medicine, Gwangju, Korea
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5
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Sundaram K, Udo-Inyang I, Mont MA, Molloy R, Higuera-Rueda C, Piuzzi NS. Vascular Injuries in Total Knee Arthroplasty: A Systematic Review and Meta-Analysis. JBJS Rev 2021; 8:e0051. [PMID: 32105241 DOI: 10.2106/jbjs.rvw.19.00051] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Vascular injuries associated with total knee arthroplasty can have limb and life-threatening consequences. The aims of this study were to conduct a meta-analysis of the overall rate of vascular injuries after total knee arthroplasty and to conduct a systematic review of specific major and minor vessel injuries. METHODS All English-language literature published from January 1, 1998, to November 30, 2018, was queried in 4 unique databases using a common search term. This yielded 404 results, of which 270 were unique. Two reviewers then assessed studies for eligibility. All non-human studies, cadaver studies, studies describing only human images, and human studies with non-acute pathology were excluded. The final study included 10 large epidemiological studies and 68 case series or studies. Data from the literature were abstracted into a comma-separated database spreadsheet using Microsoft Excel. A meta-analysis was then performed. Pooled statistics were calculated with weighting by inverse variance assuming a random effect model. I was calculated as a quantifier of heterogeneity and interpreted according to the Cochrane manual. All data analysis was performed using R software. RESULTS Among the 1,419,557 total knee arthroplasties reported in 10 studies, there were 767 major vascular injuries (0.05% [54 per 100,000 total knee arthroplasties]). Amputation or long-term neurological complications occurred in approximately 21% of patients after major vascular injury. Presentation after 24 hours occurred in 36% of cases. The most frequently injured vessels were the geniculate arteries, popliteal artery, superficial femoral artery, and anterior tibial artery. The injuries that were most likely to result in amputation were femoral artery occlusion, popliteal artery transection, and popliteal artery arteriovenous fistula. CONCLUSIONS Amputation and long-term neurological complications are common complications after a vascular injury associated with a total knee arthroplasty. Preoperative consultation with vascular surgery physicians may be a prudent approach before a surgical procedure for patients with known peripheral vascular disease, diabetes, hypertension, or smoking; however, more data on risk factors are needed. Awareness by the surgical team and implementation of specific strategies during a surgical procedure such as gentle manipulation of the knee and careful retraction may further reduce the rate of injuries. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Kavin Sundaram
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | | | - Michael A Mont
- Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, NY
| | - Robert Molloy
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | | | - Nicolas S Piuzzi
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio
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6
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Magnetic resonance imaging landmarks for preoperative localization of inferior medial genicular artery: a proof of concept analysis. J Exp Orthop 2020; 7:73. [PMID: 32989614 PMCID: PMC7522143 DOI: 10.1186/s40634-020-00288-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 09/10/2020] [Indexed: 12/02/2022] Open
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Geng X, Li Y, He X, Tian H. Traditional investigation and management for recurrent hemarthrosis after total knee arthroplasty: A case report. World J Clin Cases 2020; 8:1966-1972. [PMID: 32518788 PMCID: PMC7262716 DOI: 10.12998/wjcc.v8.i10.1966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/08/2020] [Accepted: 04/16/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Recurrent hemarthrosis is a rare complication of total knee arthroplasty, and only a few cases have been reported; hence, it is hard to establish comprehensive diagnosis and treatment guidelines. We here report a case of recurrent hemarthrosis after total knee arthroplasty, and briefly review the literature.
CASE SUMMARY A 50-year-old man, with a history of hypertension, presented to the Orthopedic Department of our hospital for non-traumatic acute left knee pain and swelling associated with a warmth sensation 14 mo after total knee arthroplasty. Investigations (ultrasound, aspiration, and arthroscopy) and managements (non-surgical, arthroscopy and open exploration) were performed, and the clinical effects of these interventions were analyzed separately. Clinical evidence indicates that the cause of this case was rupture of a pseudoaneurysm of the medial superior genicular artery.
CONCLUSION The present case indicated that angiography is essential in cases of hemarthrosis after TKA; arthroscopy may not always be adequate as it may not provide a clear view; and traditional open exploration is still effective and sometimes necessary.
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Affiliation(s)
- Xiao Geng
- Orthopedic Department, Peking University Third Hospital, Beijing 100191, China
| | - Yang Li
- Orthopedic Department, Peking University Third Hospital, Beijing 100191, China
| | - Xuan He
- Orthopedic Department, Peking University Third Hospital, Beijing 100191, China
| | - Hua Tian
- Orthopedic Department, Peking University Third Hospital, Beijing 100191, China
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8
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Luyckx EGR, Mondelaers AMP, van der Zijden T, Voormolen MHJ, Van den Bergh FRA, d'Archambeau OC. Geniculate Artery Embolization in Patients With Recurrent Hemarthrosis After Knee Arthroplasty: A Retrospective Study. J Arthroplasty 2020; 35:550-556. [PMID: 31601456 DOI: 10.1016/j.arth.2019.09.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 08/23/2019] [Accepted: 09/09/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Recurrent hemarthrosis after knee arthroplasty is an uncommon and disabling complication of this frequently performed procedure. Selective endovascular embolization of the geniculate arteries is one of the therapeutic options to manage this complication. The purpose of this study is to analyze the effectiveness of this treatment in patients suffering from recurrent hemarthrosis after knee arthroplasty. METHODS We performed a retrospective study of 31 patients (39 embolization procedures) with recurrent hemarthrosis after knee arthroplasty. There were 17 men and 14 women with a median age of 67 years (range 48-90). All patients were referred for geniculate artery embolization between January 2007 and November 2016. RESULTS Twenty-seven procedures were executed on the right side and 12 on the left side. Total knee arthroplasty was performed on 29 patients, only 2 patients underwent unicompartmental knee arthroplasty. Embolization of the superior geniculate arteries was achieved in all patients. In 12 of 39 procedures (31%), at least 1 of the inferior geniculate arteries could not be catheterized, therefore embolization was achieved through collaterals. Symptomatic improvement was observed in 26 of 31 patients (84%). Discomfort or mild postprocedural pain was observed in most patients, needing only minor pain medication, mostly resolving within 24 hours. Two patients presented with a severe complication: a 48-year-old male patient developed septic arthritis and an 85-year-old hypertensive female patient treated with anticoagulants showed aseptic necrosis of the femoral condyles. CONCLUSION Embolization of geniculate arteries is a safe and effective treatment in recurrent hemarthrosis post knee arthroplasty. Clinical improvement was seen in most patients.
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Affiliation(s)
- Elisa G R Luyckx
- Department of Radiology, Antwerp University Hospital, Edegem, Belgium; Department of Medical Imaging and Interventional Radiology, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Annelies M P Mondelaers
- Department of Radiology, Antwerp University Hospital, Edegem, Belgium; Department of Medical Imaging and Interventional Radiology, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | | | - Maurits H J Voormolen
- Department of Radiology, Antwerp University Hospital, Edegem, Belgium; Department of Medical Imaging and Interventional Radiology, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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Held MB, Grosso MJ, Sarpong NO, Hamilton WG, Sista AK, Macaulay W. Recurrent Hemarthrosis Following Total Knee Arthroplasty. JBJS Rev 2019; 7:e2. [PMID: 31663920 DOI: 10.2106/jbjs.rvw.19.00012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» Recurrent hemarthrosis is a treatable complication following total knee arthroplasty that can cause debilitating symptoms that can affect outcomes following a total knee arthroplasty.» Making a diagnosis of recurrent hemarthrosis can be difficult, especially if providers are not familiar with this potential complication.» The use of lower-extremity magnetic resonance angiography has been shown to be successful in diagnosing this potential complication.» Current management strategies range from conservative therapy to targeted genicular artery embolization to arthroscopic and open synovectomy.» Prompt identification and treatment of hemarthrosis following total knee arthroplasty are critical to avoid permanent limitations of range of motion that may jeopardize the postoperative outcome.
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Affiliation(s)
- Michael B Held
- Department of Orthopaedic Surgery, New York Presbyterian Hospital and Columbia University Medical Center, New York, NY
| | - Matthew J Grosso
- Department of Orthopaedic Surgery, New York Presbyterian Hospital and Columbia University Medical Center, New York, NY
| | - Nana O Sarpong
- Department of Orthopaedic Surgery, New York Presbyterian Hospital and Columbia University Medical Center, New York, NY
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Daniels SP, Sneag DB, Berkowitz JL, Trost D, Endo Y. Pseudoaneurysm after total knee arthroplasty: imaging findings in 7 patients. Skeletal Radiol 2019; 48:699-706. [PMID: 30306198 DOI: 10.1007/s00256-018-3084-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 08/29/2018] [Accepted: 09/23/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To describe the clinical presentation of arterial pseudoaneurysms following total knee arthroplasty (TKA) and their diagnostic imaging features on ultrasound and magnetic resonance angiography (MRA) in 7 patients. MATERIALS AND METHODS A search of our radiology report database from 2007 to 2017 yielded 7 patients with a pseudoaneurysm diagnosed by imaging after TKA. Clinical notes and imaging were reviewed. RESULTS All 7 patients were male and ranged in age from 53 to 68 (mean 61) years. All patients presented with a painful swollen knee and hemarthrosis within the first month following surgery. Five patients presented after primary TKA. One patient presented after explantation for septic arthritis and another after partial synovectomy for septic arthritis without explantation. Ultrasound identified the pseudoaneurysm as a hypoechoic or hyperechoic mass with a "yin-yang" appearance of turbulent arterial flow and associated complex joint effusion. On MRA, the pseudoaneurysm was a mass next to a parent artery showing avid contrast enhancement in the arterial phase that persisted into the venous phase and washed out in the late venous phase. Six pseudoaneurysms arose from lateral geniculate arteries and 1 from a medial geniculate artery. There were no popliteal artery pseudoaneurysms. Five patients were treated endovascularly, 1 patient thrombosed without intervention, and 1 patient was treated with open surgery. CONCLUSION Pseudoaneurysm is a potential source of a painful swollen knee with hemarthrosis or a drop in hematocrit after TKA and can be identified with either ultrasound or MRA.
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Affiliation(s)
- Steven P Daniels
- Department of Radiology, New York Presbyterian Hospital-Weill Cornell Medical Center, 525 East 68th Street, Box 141, New York, NY, 10065, USA
| | - Darryl B Sneag
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 E. 70th Street, New York, NY, 10021, USA
| | - Jennifer L Berkowitz
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 E. 70th Street, New York, NY, 10021, USA
| | - David Trost
- Department of Radiology, New York Presbyterian Hospital-Weill Cornell Medical Center, 525 East 68th Street, Box 141, New York, NY, 10065, USA
| | - Yoshimi Endo
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 E. 70th Street, New York, NY, 10021, USA.
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Yoo JH, Oh HC, Park SH, Lee S, Lee Y, Kim SH. Treatment of Recurrent Hemarthrosis after Total Knee Arthroplasty. Knee Surg Relat Res 2018; 30:147-152. [PMID: 29715715 PMCID: PMC5990227 DOI: 10.5792/ksrr.17.059] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Revised: 11/03/2017] [Accepted: 12/02/2017] [Indexed: 01/19/2023] Open
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.
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Affiliation(s)
- Ju-Hyung Yoo
- Department of Orthopedic Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Hyun-Cheol Oh
- Department of Orthopedic Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Sang-Hoon Park
- Department of Orthopedic Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Sanghyeon Lee
- Department of Orthopedic Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Yunjae Lee
- Department of Orthopedic Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Seong-Hun Kim
- Department of Orthopedic Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
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The all-inside meniscal repair technique has less risk of injury to the lateral geniculate artery than the inside-out repair technique when suturing the lateral meniscus. Knee Surg Sports Traumatol Arthrosc 2018; 26:793-798. [PMID: 28289817 DOI: 10.1007/s00167-017-4490-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 02/14/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE To evaluate the risk of injury to the inferior lateral geniculate artery with two different techniques for lateral meniscus repair. METHODS Eight cadaveric knees were used. Inside-out sutures and an all-inside suture device were placed at the most lateral edge of the popliteal hiatus, and 15 and 30 mm anterior to this point. The minimum distances between the sutures and the inferior lateral geniculate artery were measured through a limited lateral arthrotomy. Artery penetration or collapse due to the sutures was also evaluated. RESULTS The median distance between the sutures and the artery when inserted at the lateral edge of the popliteal hiatus was 1.5 mm (interquartile range: 1.3) for the inside-out technique and 1.5 mm (1.3) for the all-inside technique (differences not significant, n.s.). When the sutures were inserted 15 mm anterior to the popliteal hiatus the distances were 1.0 mm (1.1) and 1.3 mm (1.0) for the inside-out technique and the all-inside technique, respectively (n.s.). When the sutures were inserted 30 mm anterior to the popliteal hiatus the distances were 1.0 mm (1.0) and 1.5 mm (1.0) for the inside-out technique and the all-inside technique, respectively (n.s.). The artery was punctured with two of the inside-out sutures placed 15 mm from the popliteal hiatus, no puncturing occurred in the all-inside technique (n.s.). Tying of the inside-out sutures resulted in obliteration of the artery in four of eight sutures placed at 15 mm from the popliteal hiatus and three of eight sutures at 30 mm; no obliteration of the artery was found using the all-inside device (significant differences, p = 0.002). CONCLUSIONS Although both all-inside and inside-out lateral meniscal repair techniques place sutures very close to the lateral geniculate artery, the inside-out technique is riskier as extra-articular knot tying can cause artery obliteration when suturing the part of the meniscus immediately lateral to the popliteal hiatus. Therefore, all-inside meniscal repair technique shows less risk of injury to the major blood supply of the lateral meniscus.
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Liu CT, Tu CL, Chao CM. Acute Hemarthrosis of the Knee Caused by Arteriovenous Malformation. J Emerg Med 2016; 51:80-1. [PMID: 27231206 DOI: 10.1016/j.jemermed.2016.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 04/01/2016] [Accepted: 04/05/2016] [Indexed: 11/18/2022]
Affiliation(s)
- Chien-Ting Liu
- Department of Emergency Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Chu-Li Tu
- Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan
| | - Chien-Ming Chao
- Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Tainan, Taiwan
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14
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A case of the geniculate artery pseudoaneurysm after total knee arthroplasty: search for preventive measures by evaluation of arterial anatomy of cadaver knees. Knee Surg Sports Traumatol Arthrosc 2013; 21:2721-4. [PMID: 22729807 DOI: 10.1007/s00167-012-2109-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2011] [Accepted: 06/12/2012] [Indexed: 10/28/2022]
Abstract
This article presents an 80-year-old man with pseudoaneurysm of the inferolateral geniculate artery after total knee arthroplasty (TKA). The aim is to report this case and review possible preventive methods of pseudoaneurysm formation after TKA by investigating the relationship between knee arterial anatomy and the TKA procedure. Cadaveric evaluation demonstrates that the superomedial and inferomedial geniculate arteries are difficult to visualize. The anatomical position of the inferolateral artery makes it vulnerable to the surgical procedure during cutting of the tibia or while retracting soft tissue from the tibial edge, especially with minimal invasive surgery. In conclusion, careful subperiosteal release around the geniculate arteries is recommended. However, early recognition of pseudoaneurysm formation is even more essential than prevention.
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15
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Geertsema D, Defoort KC, van Hellemondt GG. Popliteal pseudoaneurysm after total knee arthroplasty: a report of 3 cases. J Arthroplasty 2012; 27:1581.e1-4. [PMID: 22425296 DOI: 10.1016/j.arth.2011.11.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2011] [Revised: 10/21/2011] [Accepted: 11/27/2012] [Indexed: 02/01/2023] Open
Abstract
Although the incidence of vascular injuries after total knee arthroplasty is quite low, clinical outcome could be significantly impaired. Quick response and accurate management are important to achieve the best possible outcome. We present 3 cases of popliteal pseudoaneurysm formation after total knee arthroplasty and their treatment by endovascular stenting together with a review of literature.
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Affiliation(s)
- Dorien Geertsema
- Department of Orthopaedic Surgery, Knee Reconstruction Unit, Sint Maartenskliniek, Nijmegen, The Netherlands
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16
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Mello W, de Brito WE, Migon EZ, Borges A. Pseudoaneurysm of the medial inferior genicular artery after anterior cruciate ligament reconstruction. Arthroscopy 2011; 27:442-5. [PMID: 21353173 DOI: 10.1016/j.arthro.2010.10.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2010] [Revised: 10/20/2010] [Accepted: 10/29/2010] [Indexed: 02/02/2023]
Abstract
We present a case of pseudoaneurysm formation of the medial inferior genicular artery after anterior cruciate ligament reconstruction. The patient presented with repeated knee hemarthrosis. He was diagnosed by means of magnetic resonance angiography and was treated by means of transluminal embolization. The patient's normal was normal after resolution of the vascular pathologic condition.
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Affiliation(s)
- Wilson Mello
- Instituto Wilson Mello and Pontifícia Universidade Católica de Campinas, Campinas, Brazil.
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17
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Saksena J, Platts AD, Dowd GSE. Recurrent haemarthrosis following total knee replacement. Knee 2010; 17:7-14. [PMID: 19616438 DOI: 10.1016/j.knee.2009.06.008] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2009] [Revised: 06/18/2009] [Accepted: 06/20/2009] [Indexed: 02/02/2023]
Abstract
Total knee replacement is a well-established treatment for osteoarthritis with increasing numbers performed each year. Recurrent haemarthrosis is a relatively rare complication following TKR being reported in up to 1.6% of patients. While some causes are related to direct trauma to blood vessels, others are more obscure and may be difficult to diagnose. The purpose of this review is to give an overview of this unusual complication and summarise the current methods of management.
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Affiliation(s)
- J Saksena
- The Whittington Hospital, Magdala Avenue, Archway, London, N19 5NF, United Kingdom.
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18
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Rukavina A, Kerkhoffs GMMJ, Schneider P, Kuster MS. Recurrent hemarthrosis after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2010; 18:898-900. [PMID: 20076944 PMCID: PMC2887507 DOI: 10.1007/s00167-009-1031-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2009] [Accepted: 12/14/2009] [Indexed: 12/22/2022]
Abstract
This report describes a case of spontaneous recurrent hemarthrosis of the knee that presented 4 weeks after total knee arthroplasty. Femoral arteriography showed a false aneurysm of a branch of the inferior lateral geniculate artery. Therapeutic embolization of the arterial branch was performed using three platinum coils with good clinical result and good knee joint function. Hemarthrosis has not recurred since embolization.
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Affiliation(s)
- Alexander Rukavina
- Department of Orthopedic Surgery and Traumatology, Kantonsspital, St. Gallen, Switzerland ,Department of Orthopedic Surgery, Klinik Orthopaedie am See, Kreuzlingen, Switzerland
| | - Gino M. M. J. Kerkhoffs
- Department of Orthopedic Surgery and Traumatology, Kantonsspital, St. Gallen, Switzerland ,Department of Orthopedic Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | | | - Markus S. Kuster
- Department of Orthopedic Surgery and Traumatology, Kantonsspital, St. Gallen, Switzerland
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19
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Shaw A, Stephen A, Lund J, Bungay P, Denunzio M. Geniculate arterial pseudoaneurysm formation following trauma and elective orthopaedic surgery to the knee: 2 case reports and a review of the literature. J Radiol Case Rep 2009; 3:12-6. [PMID: 22470647 DOI: 10.3941/jrcr.v3i3.42] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Arterial pseudoaneurysm formation of the genicular vessels following orthopaedic surgery to the knee is an extremely rare occurrence. Here we report the successful management of two cases as a complication of total knee arthroplasty and a tibial interlocking nail, utilising coil embolisation by interventional radiological techniques and negating the need for further surgery. To our knowledge this is one of the few reported cases of pseudoaneurysms of the descending genicular artery secondary to drain placement and only the second following tibial interlocking nail placement.
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Affiliation(s)
- A Shaw
- Department of Medicine and Healthcare, University of Nottingham, Derby, UK
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20
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Pseudoaneurysm of the lateral geniculate artery at the distal interlocking screw site. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2008. [DOI: 10.1007/s00590-008-0405-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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21
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Kapetanos GA, Papavasiliou KA, Makris V, Nikolaides AP, Kirkos JM, Symeonides PP. Recurrent spontaneous hemarthrosis after total knee arthroplasty successfully treated with synoviorthesis. J Arthroplasty 2008; 23:931-3. [PMID: 18534524 DOI: 10.1016/j.arth.2007.07.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2006] [Revised: 03/04/2007] [Accepted: 07/23/2007] [Indexed: 02/01/2023] Open
Abstract
A case of spontaneous recurrent hemarthrosis--due to developed hypertrophied synovium--after total knee arthroplasty is reported. The patient was successfully treated with radiosynovectomy. The first hemorrhage occurred 18 months after the total knee arthroplasty. Several similar episodes followed over a period of 4 years. Because conservative treatment failed to control the bleeding, an arthroscopic lavage was performed, which revealed the existence of proliferative synovium. A significant part of the hypertrophic tissue was excised with the use of a thermocoagulator. However, 1 month later, another episode of hemarthrosis occurred. As a final step before reoperation, the patient was treated with intra-articular injection of ytrium 90. Eighteen months later, she remains symptom-free, is very satisfied with the result, and reports no new episode of hemarthrosis.
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Affiliation(s)
- George A Kapetanos
- Third Orthopaedic Department, Aristotle University of Thessaloniki Medical School, Papageorgiou General Hospital, Thessaloniki, Greece
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22
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Imaging appearances and endovascular management of uncommon pseudoaneurysms. Clin Radiol 2008; 63:1254-64. [PMID: 18929043 DOI: 10.1016/j.crad.2008.04.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2008] [Revised: 04/07/2008] [Accepted: 04/08/2008] [Indexed: 11/20/2022]
Abstract
Pseudoaneurysms are uncommon and their aetiology is varied. They occur in numerous anatomical locations and present with a multitude of clinical presentations sometimes life-threatening. This review describes the causes, sites, and presentations of uncommon pseudoaneurysms, as well as illustrating their diagnostic appearances and endovascular management.
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23
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Delayed diagnosis of a pseudoaneurysm with recurrent hemarthrosis of the knee joint. Knee Surg Sports Traumatol Arthrosc 2008; 16:561-4. [PMID: 18305923 DOI: 10.1007/s00167-008-0505-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2008] [Accepted: 02/04/2008] [Indexed: 01/12/2023]
Abstract
This is a case report of recurrent hemarthrosis of the knee joint over 3 months. The patient, a 47-year-old male had three arthroscopic procedures with multiple joint punctures over a 3-month-period prior to our initial consultation. The first procedure (arthroscopic synovectomy) was done for suspected infection following a series of hyaluronic acid injections. Recurrent hemarthrosis developed subsequent to this. Upon further evaluation, a pseudoaneurysm of the superior middle genicular artery was detected and successfully treated with selective angiographic embolization.
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24
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Giordano P, Del Vecchio GC, Scaraggi R, Cardinale F, Moretti B, Lassandro G, De Mattia D. Hemarthrosis due to a rare cause of hemorrhagic diathesis: Ehlers-Danlos syndrome. Pediatr Hematol Oncol 2008; 25:205-9. [PMID: 18432503 DOI: 10.1080/08880010801938017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The authors report a case of hemarthrosis complicated by severe anemia related to a congenital connective tissue disease: Ehlers-Danlos syndrome. A boy fell down and suffered tumefaction of both knees with bilateral rupture of the rotula tendon. He underwent surgical reinsertion of each tendon on the rotula. He later showed an unexpected ongoing hematic effusion, with severe anemia. He was screened for coagulation disorders with no results. On taking a more detailed history and investigating the patient's phenotypical features, the authors diagnosed Ehlers-Danlos syndrome, hypermobile variant. The hemarthrosis and anemia were thus concluded to be consequences of excessive tissue fragility due to a congenital connective tissue disease.
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Affiliation(s)
- Paola Giordano
- Dipartimento di Biomedicina dell'età evolutiva, Bari University, Bari, Italy.
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25
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Law KY, Cheung KW, Chiu KH, Antonio GE. Pseudoaneurysm of the geniculate artery following total knee arthroplasty: a report of two cases. J Orthop Surg (Hong Kong) 2007; 15:386-9. [PMID: 18162694 DOI: 10.1177/230949900701500331] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We report 2 cases of pseudoaneurysm of the geniculate artery after a total knee arthroplasty (TKA). The first one was located in the superomedial geniculate artery and resolved after compression dressing and warfarin cessation. The second one was located in the superolateral geniculate artery and was successfully treated with transarterial embolisation. There was no recurrence in both cases. The rare occurrence and delayed presentation of pseudoaneurysms pose a diagnostic challenge. A high index of suspicion is required to make the diagnosis. Early duplex Doppler ultrasonography is recommended when patients present with atypical knee pain and prolonged swelling after a TKA.
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Affiliation(s)
- K Y Law
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Shatin, New Territories, Hong Kong.
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26
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Sinha S, Lewis MH. Recurrent haemarthrosis of knee joint due to arterio-venous malformation of the superficial femoral artery. Surgeon 2007; 5:313-315. [PMID: 17958232 DOI: 10.1016/s1479-666x(07)80031-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Recurrent haemarthrosis involving the knee joint is commonly due to bleeding, a coagulation disorder or previous surgery. We have recently encountered a case of recurrent haemarthrosis involving the left knee joint of a 72 year old man due to arterio-venous malformation of the superficial femoral artery. Vascular malformations in patients with recurrent haemarthrosis without previous history of operation and a normal bleeding and clotting screen, should be considered a possible cause.
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Affiliation(s)
- S Sinha
- Royal Glamorgan Hospital, Ynys Maerdy, Liantrisant.
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27
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Behnke NM, Cui Q, Orndorff D. Late Presentation of a Mycotic Popliteal Artery Pseudoaneurysm in the Setting of a Revised Total Knee Arthroplasty Complicated by Both Prior Infection and Periprosthetic Fracture: A Case Report. Ann Vasc Surg 2007; 21:519-24. [PMID: 17532606 DOI: 10.1016/j.avsg.2007.01.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2006] [Revised: 01/28/2007] [Accepted: 01/29/2007] [Indexed: 01/06/2023]
Abstract
Reports of adverse arterial events associated with total knee arthroplasty (TKA), such as ischemia, thrombosis, arterial injury, or pseudoaneurysm, are relatively rare in the orthopedic and vascular literature and are most commonly associated with direct trauma to the vessel. Additionally, arterial complications typically present within a short postoperative time frame. A delayed presentation of a mycotic arterial pseudoaneurysm in the setting of a revision arthroplasty complicated by infection and fracture has not, to the best knowledge of the authors, been described in the literature. We report the delayed presentation of a mycotic pseudoaneurysm in the setting of a revision TKA previously complicated by both infection and periprosthetic fracture. One year after fracture repair, the patient presented with acute thigh swelling and was diagnosed with a mycotic pseudoaneurysm of the right proximal popliteal artery. He was treated with surgical excision, reverse saphenous vein interpositional grafting, and a long-term course of broad-spectrum antibiotics. In the setting of a revision TKA and previous complications, the risk of future complications is increased and may not always involve direct vascular trauma. In patients with previously infected joints and new-onset vascular events, mycotic pseudoaneurysm must be included in the differential diagnosis.
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28
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Mounasamy V, Dawson C, Cui Q, Mihalko WM, Saleh KJ, Brown T. Popliteal artery pseudoaneurysm following total knee arthroplasty: a case report. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2006. [DOI: 10.1007/s00590-006-0167-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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