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Salm SAAA, Alzubaidi AHA, Leusink RJ. Genicular artery embolization for recurrent hemarthrosis: A case report. Radiol Case Rep 2024; 19:2337-2342. [PMID: 38532912 PMCID: PMC10963894 DOI: 10.1016/j.radcr.2024.02.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 02/15/2024] [Accepted: 02/22/2024] [Indexed: 03/28/2024] Open
Abstract
A 44-year-old otherwise healthy male with a history of trauma and surgical interventions in his right knee presented to the emergency department with repeated hemarthrosis of the right knee. The patient underwent blood tests, X-rays, and magnetic resonance imaging of the knee. A computed tomography angiography revealed blushing of the synovium of the knee. The patient underwent successful embolization of the genicular artery branches. Hemarthrosis did not recur. The use of genicular artery embolization, in our case, not only successfully addressed recurrent hemarthrosis but also underscores its emerging role in comprehensive patient management. This minimally invasive approach, precisely targeting the vascular supply to the affected synovium, offers an effective alternative where conventional therapies may fall short. Beyond symptom relief, it holds promise for preventing hemarthrosis recurrence, a valuable addition to clinicians' interventions for challenging knee joint bleeding cases. Further investigation in larger cohorts and comparative studies may reveal its broader applicability and long-term efficacy, shaping treatment options for recurrent hemarthrosis.
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Affiliation(s)
| | | | - Robert Johannes Leusink
- Department of Radiology, Vascular Interventional Section, Aalborg University Hospital, Aalborg, North Jutland, Denmark
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2
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Chau Y, Roux C, Gonzalez JF, Breuil V, Bernard de Dompsure R, Fontas E, Rudel A, Sédat J. Effectiveness of Geniculate Artery Embolization for Chronic Pain after Total Knee Replacement-A Pilot Study. J Vasc Interv Radiol 2023; 34:1725-1733. [PMID: 37391071 DOI: 10.1016/j.jvir.2023.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 05/19/2023] [Accepted: 06/20/2023] [Indexed: 07/02/2023] Open
Abstract
PURPOSE To evaluate the efficacy and safety of embolization of hyperemic synovial tissue for the treatment of persistent pain after total knee arthroplasty (TKA). MATERIALS AND METHODS Twelve patients with persistent pain after TKA were enrolled in this prospective, single-center pilot study. Genicular artery embolization (GAE) was performed using 75-μm spherical particles. The patients were assessed using a 100-point Visual Analog Scale (VAS) and Knee Injury and Osteoarthritis Outcome Score (KOOS) at baseline and 3 and 6 months thereafter. Adverse events were recorded at all time points. RESULTS A mean of 1.8 ± 0.8 abnormal hyperemic genicular arteries were identified and embolized, with a median volume of diluted embolic material of 4.3 mL in all 12 (100%) patients. The mean VAS score on walking improved from 73 ± 16 at baseline to 38 ± 35 at the 6-month follow-up (P < .05). The mean KOOS pain score improved from 43.6 ± 15.5 at baseline to 64.6 ± 27.1 at the 6-month follow-up (P < .05). At the 6-month follow-up, 55% and 73% of the patients attained a minimal clinically important change in pain and quality of life, respectively. Self-limited skin discoloration occurred in 5 (42%) patients. The VAS score increased by more than 20 immediately after embolization in 4 (30%) patients, who required analgesic treatment for 1 week. CONCLUSION GAE is a safe method of treating persistent pain after TKA that demonstrates potential efficacy at 12 months.
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Affiliation(s)
- Yves Chau
- Neurointerventionnal and Interventional Vascular Unit, CHU de Nice, Pasteur 2 Hospital, Nice, France.
| | - Christian Roux
- Department of Rheumatology, CHU de Nice, Pasteur 2 Hospital, Nice, France
| | | | - Véronique Breuil
- Department of Rheumatology, CHU de Nice, Pasteur 2 Hospital, Nice, France
| | | | - Eric Fontas
- Department of Clinical Research and Innovation, CHU de Nice, Pasteur 2 Hospital, Nice, France
| | - Alexandre Rudel
- Department of Osteo-Articular Radiology, CHU de Nice, Pasteur 2 Hospital, Nice, France
| | - Jacques Sédat
- Neurointerventionnal and Interventional Vascular Unit, CHU de Nice, Pasteur 2 Hospital, Nice, France
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3
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Emerging Targets for the Treatment of Osteoarthritis: New Investigational Methods to Identify Neo-Vessels as Possible Targets for Embolization. Diagnostics (Basel) 2022; 12:diagnostics12061403. [PMID: 35741213 PMCID: PMC9221854 DOI: 10.3390/diagnostics12061403] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 05/24/2022] [Accepted: 05/27/2022] [Indexed: 12/14/2022] Open
Abstract
Osteoarthritis (OA) is the major cause of disability, affecting over 30 million US adults. Continued research into the role of neovascularization and inflammation related to osteoarthritis in large-animal models and human clinical trials is paramount. Recent literature on the pathogenetic model of OA has refocused on low-level inflammation, resulting in joint remodeling. As a result, this has redirected osteoarthritis research toward limiting or treating joint changes associated with persistent synovitis. The overall goal of this review is to better understand the cellular and tissue-specific mechanisms of inflammation in relation to a novel OA treatment modality, Genicular Artery Embolization (GAE). This article also assesses the utility and mechanism of periarticular neovascular embolization for the treatment of OA with a particular emphasis on the balance between pro-angiogenic and anti-angiogenic cytokines, inflammatory biomarkers, and imaging changes.
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4
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Samim M, Khodarahmi I, Burke C, Fritz J. Postoperative Musculoskeletal Imaging and Interventions Following Hip Preservation Surgery, Deformity Correction, and Hip Arthroplasty. Semin Musculoskelet Radiol 2022; 26:242-257. [PMID: 35654093 DOI: 10.1055/s-0041-1740996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Total hip arthroplasty and hip preservation surgeries have substantially increased over the past few decades. Musculoskeletal imaging and interventions are cornerstones of comprehensive postoperative care and surveillance in patients undergoing established and more recently introduced hip surgeries. Hence the radiologist's role continues to evolve and expand. A strong understanding of hip joint anatomy and biomechanics, surgical procedures, expected normal postoperative imaging appearances, and postoperative complications ensures accurate imaging interpretation, intervention, and optimal patient care. This article presents surgical principles and procedural details pertinent to postoperative imaging evaluation strategies after common hip surgeries, such as radiography, ultrasonography, computed tomography, and magnetic resonance imaging. We review and illustrate the expected postoperative imaging appearances and complications following chondrolabral repair, acetabuloplasty, osteochondroplasty, periacetabular osteotomy, realigning and derotational femoral osteotomies, and hip arthroplasty.
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Affiliation(s)
- Mohammad Samim
- Division of Musculoskeletal Radiology, Department of Radiology, NYU Grossman School of Medicine, New York, New York
| | - Iman Khodarahmi
- Division of Musculoskeletal Radiology, Department of Radiology, NYU Grossman School of Medicine, New York, New York
| | - Christopher Burke
- Division of Musculoskeletal Radiology, Department of Radiology, NYU Grossman School of Medicine, New York, New York
| | - Jan Fritz
- Division of Musculoskeletal Radiology, Department of Radiology, NYU Grossman School of Medicine, New York, New York
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Predictive Variables for Interventional Angiography among Patients with Knee Hemarthrosis. Diagnostics (Basel) 2022; 12:diagnostics12040976. [PMID: 35454024 PMCID: PMC9025792 DOI: 10.3390/diagnostics12040976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 04/08/2022] [Accepted: 04/11/2022] [Indexed: 11/16/2022] Open
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.
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Cornman-Homonoff J, Kishore SA, Waddell BS, Kesler J, Mandl LA, Westrich GH, Potter HG, Trost DW. Genicular Artery Embolization for Refractory Hemarthrosis following Total Knee Arthroplasty: Technique, Safety, Efficacy, and Patient-Reported Outcomes. J Vasc Interv Radiol 2021; 32:1128-1135. [PMID: 33961990 DOI: 10.1016/j.jvir.2021.04.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 03/22/2021] [Accepted: 04/18/2021] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To investigate the safety and efficacy of genicular artery embolization for treatment of refractory hemarthrosis following total knee arthroplasty. MATERIAL AND METHODS Patients who underwent genicular artery embolization with spherical embolics between January 2010 and March 2020 at a single institution were included if they had undergone total knee arthroplasty and subsequently experienced recurrent hemarthrosis. Technical success was defined as the significant reduction or elimination of the hyperemic blush. Clinical success was defined as the absence of clinical evidence of further hemarthrosis. Clinical follow-up was performed 7-14 days after the procedure and at 3-month intervals thereafter via a telephone interview. A total of 117 embolizations, comprising 82 initial, 28 first repeat, and 7 second repeat, were performed. RESULTS An average of 2.5 arteries was treated per procedure. The superior lateral genicular artery was the most frequently embolized. The most utilized embolic size was 100-300 μm. Follow-up was available for all patients, with a median duration of 21.5 months. 65.9%, 25.6%, and 8.5% of patients underwent 1, 2, and 3 treatments, respectively. Complications occurred following 12.8% of treatments, of which the most common was transient cutaneous ischemia. Technical success was achieved in all cases. Clinical success was achieved in 56%, 79%, and 85% of patients following the first, second, and third treatment, respectively. 83% of patients reported being either satisfied or very satisfied with the overall result. CONCLUSIONS Targeted genicular artery embolization with spherical embolics is an effective treatment for recurrent hemarthrosis with infrequent serious complications. Repeat embolization should be considered in cases of recurrence following initial therapy.
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Affiliation(s)
- Joshua Cornman-Homonoff
- Department of Radiology, Division of Interventional Radiology, NewYork-Presbyterian/Weill Cornell Medical Center, New York, New York.
| | - Sirish A Kishore
- Department of Radiology, Division of Interventional Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Bradford S Waddell
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Jacqueline Kesler
- Department of Radiology, Division of Interventional Radiology, NewYork-Presbyterian/Weill Cornell Medical Center, New York, New York
| | - Lisa A Mandl
- Department of Medicine, Hospital for Special Surgery, New York, New York
| | - Geoffrey H Westrich
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Hollis G Potter
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York
| | - David W Trost
- Department of Radiology, Division of Interventional Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
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Pow R, Fritsch B, Waugh R, Rogan C. Endovascular management of recurrent hemarthrosis of the knee: a case series. CVIR Endovasc 2020; 3:43. [PMID: 32864716 PMCID: PMC7456626 DOI: 10.1186/s42155-020-00135-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 06/23/2020] [Indexed: 11/23/2022] Open
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.
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Affiliation(s)
- Richard Pow
- Royal Prince Alfred Hospital, 50 Missenden Road, Camperdown, Sydney, New South Wales, 2050, Australia.
| | - Brett Fritsch
- Royal Prince Alfred Hospital, 50 Missenden Road, Camperdown, Sydney, New South Wales, 2050, Australia
| | - Richard Waugh
- Royal Prince Alfred Hospital, 50 Missenden Road, Camperdown, Sydney, New South Wales, 2050, Australia
| | - Chris Rogan
- Royal Prince Alfred Hospital, 50 Missenden Road, Camperdown, Sydney, New South Wales, 2050, Australia
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Power SP, Cairns B, Prabhudesai V, Marcuzzi D, Waddell JP, Vincent G, Common AA. Genicular Artery Embolization for Recurrent Hemarthrosis of the Knee Following Total Knee Arthroplasty: A Single Centre Experience. Can Assoc Radiol J 2020; 72:571-576. [PMID: 32204610 DOI: 10.1177/0846537119899550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To retrospectively review the safety and efficacy of genicular artery embolization procedures performed at our institution in patients presenting with recurrent knee hemarthrosis following total knee arthroplasty (TKA). MATERIALS AND METHODS A total of 13 consecutive patients (average age: 68; range 51-84, 62% female) were identified who underwent 14 genicular artery embolization procedures after presenting with recurrent hemarthrosis after TKA. Patient charts were retrospectively reviewed for demographic information, pre-embolization investigations, and details of embolization procedure including complications, technical success, and clinical success. Each patient had failed initial conservative therapy and all patients had a diagnostic aspiration performed by the referring physician prior to the procedure. The average time between TKA and embolization in our cohort was 21 months. RESULTS All procedures performed were technically successful, defined as elimination of periprosthetic hypervascular blush. An average of 3.6 genicular vessels were embolized in each patient; 355 to 500 µm polyvinyl alcohol (PVA) particles were used in each case. There were no cases of transient cutaneous ischemia, skin erythema, or skin necrosis. Clinical success was obtained in 85.7% of cases, defined by elimination of the presenting clinical symptoms (knee pain and swelling) during continued follow-up by the referring clinician. CONCLUSION Particle embolization is a safe and effective treatment for recurrent hemarthrosis after arthroplasty and our experience suggests that utilizing particle sizes of greater than 300 µm appears to be important in order to avoid cutaneous ischemic complications.
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Affiliation(s)
- Stephen P Power
- Department of Medical Imaging, 10071St. Michael's Hospital, Toronto, Ontario, Canada
| | - Brooke Cairns
- Department of Medical Imaging, Kelowna General Hospital, Kelowna, British Columbia, Canada
| | - Vikramaditya Prabhudesai
- Department of Medical Imaging, 10071St. Michael's Hospital, Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Dan Marcuzzi
- Department of Medical Imaging, 10071St. Michael's Hospital, Toronto, Ontario, Canada
| | - James P Waddell
- Division of Orthopaedic Surgery, Department of Surgery, St. Michael's Hospital, Toronto, Ontario, Canada
| | - George Vincent
- Division of Orthopaedic Surgery, Department of Surgery, St. Joseph's Healthcentre, Toronto, Ontario, Canada
| | - Andrew A Common
- Department of Medical Imaging, 10071St. Michael's Hospital, Toronto, Ontario, Canada
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Chau Y, Roux C, Breuil V, Trojani C, Gonzalez JF, Amoretti N, Sédat J. Endovascular Occlusion of Neovascularization as a Treatment for Persistent Pain After Total Knee Arthroplasty. Cardiovasc Intervent Radiol 2020; 43:787-790. [PMID: 32144433 DOI: 10.1007/s00270-020-02449-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 02/28/2020] [Indexed: 11/26/2022]
Abstract
Approximately 20% of patients have persistent unexplained pain after total knee arthroplasty (TKA). Currently available treatments are unsatisfactory. The present report describes four patients in whom transcatheter arterial embolization had a remarkable effect on pain after TKA. Abnormal neovessels were identified in all patients. For 48 h, one patient experienced remarkable postprocedural pain at the inner side of the knee that was subsided by level 1 analgesics and another patient development of a spontaneous skin ulceration resolving within 8 days. The mean Knee injury and Osteoarthritis Outcome Score pain subtotal had increased from 39 to 82 one month after treatment. Endovascular occlusion of neovascularization, decreasing chronic inflammation and the growth of unmyelinated sensory nerves may be treatment options for persistent unexplained pain following TKA.Level of Evidence IV, Case report.
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Affiliation(s)
- Yves Chau
- Neurointerventional and Interventional Vascular Unit, Université Côte d'Azur (UCA), Hôpital Pasteur 2, CHU Nice, 30 Voie Romaine, Nice, France.
| | - Christian Roux
- Department of Rheumatology, Université Côte d'Azur (UCA), Hôpital Pasteur 2, Nice, France
| | - Véronique Breuil
- Department of Rheumatology, Université Côte d'Azur (UCA), Hôpital Pasteur 2, Nice, France
| | - Christophe Trojani
- Department of Orthopedic Surgery, Université Côte d'Azur (UCA), Hôpital Pasteur 2, Nice, France
| | - Jean-François Gonzalez
- Department of Orthopedic Surgery, Université Côte d'Azur (UCA), Hôpital Pasteur 2, Nice, France
| | - Nicolas Amoretti
- Department of Osteointerventional Radiology, Université Côte d'Azur (UCA), Hôpital Pasteur 2, Nice, France
| | - Jacques Sédat
- Neurointerventional and Interventional Vascular Unit, Université Côte d'Azur (UCA), Hôpital Pasteur 2, CHU Nice, 30 Voie Romaine, Nice, France
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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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Successful Selective Embolization for Recurrent Hemarthrosis after Knee Arthroplasty. Case Rep Orthop 2019; 2019:8374709. [PMID: 31885988 PMCID: PMC6915123 DOI: 10.1155/2019/8374709] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 11/22/2019] [Indexed: 11/17/2022] Open
Abstract
Knee replacement has demonstrated to be a cost-effective treatment for severe knee osteoarthritis. Nevertheless, perioperative complications may occur, including recurrent hemarthrosis reaching an incidence between 0.3 and 1.6%. Success rate after conservative treatment has been reported to be above 80%, but in case of recurrence, computed tomography angiography, magnetic resonance angiography, and Doppler ultrasound have been used to conduct the diagnosis. Arthroscopy or selective embolization is used for treatment depending on the etiology of the bleeding. Open surgery is performed in the rare cases of failure of the above alternatives. The patient consulted seven months after total knee arthroplasty with sudden pain in the medial side of the knee. Infection was ruled out, and arthrocentesis shows hemarthrosis. Successful selective embolization of medial superior and lateral superior genicular artery was performed. After two years, the patients report 92 points in the Forgotten joint score, 0 in Womac pain, 1 in Womac stiffness, and 3 in Womac functional score.
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12
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Endovascular Management of Hemarthrosis in Patients with Bleeding Diatheses: Systematic Review. Cardiovasc Intervent Radiol 2019; 43:362-368. [PMID: 31690982 DOI: 10.1007/s00270-019-02367-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 10/23/2019] [Indexed: 02/08/2023]
Abstract
PURPOSE In this systematic review, we report the safety and efficacy of embolization for treating hemarthrosis in patients with bleeding diatheses with or without a history of prior arthroplasty. MATERIALS AND METHODS A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. A structured search was performed in PubMed, Web of Science, MEDLINE, and SCOPUS databases of patients undergoing embolization for hemarthrosis. Demographic data, clinical history, angiographic findings, interventions, and outcomes were extracted and tabulated. RESULTS The search identified 97 unique titles of which 15 were deemed relevant comprising 78 patients with coagulopathies undergoing 93 embolization procedures. Mean follow-up time was 29 months (range 3-116.5). In the 29 patients who underwent arthroplasty prior to embolization for hemarthrosis, there were 11 bleeding recurrences (37.9%). Of these patients who experienced recurrences, 10 underwent repeat embolization as coagulation factor replacement was not sufficient to address the re-bleeding. In the 49 patients with bleeding diatheses who underwent embolization for hemarthrosis with no history of prior arthroplasty, there were 11 recurrences (22.4%) and 4 of these patients underwent repeat embolization with favorable results. There were four major procedure-related complications. CONCLUSION Transarterial embolization is safe and effective in addressing recurrent hemarthrosis in patients with bleeding diatheses with or without a history of arthroplasty of the affected joint.
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13
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Wyseure T, Yang T, Zhou JY, Cooke EJ, Wanko B, Olmer M, Agashe R, Morodomi Y, Behrendt N, Lotz M, Morser J, von Drygalski A, Mosnier LO. TAFI deficiency causes maladaptive vascular remodeling after hemophilic joint bleeding. JCI Insight 2019; 4:128379. [PMID: 31465300 PMCID: PMC6795396 DOI: 10.1172/jci.insight.128379] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 08/23/2019] [Indexed: 12/23/2022] Open
Abstract
Excessive vascular remodeling is characteristic of hemophilic arthropathy (HA) and may contribute to joint bleeding and the progression of HA. Mechanisms for pathological vascular remodeling after hemophilic joint bleeding are unknown. In hemophilia, activation of thrombin-activatable fibrinolysis inhibitor (TAFI) is impaired, which contributes to joint bleeding and may also underlie the aberrant vascular remodeling. Here, hemophilia A (factor VIII-deficient; FVIII-deficient) mice or TAFI-deficient mice with transient (antibody-induced) hemophilia A were used to determine the role of FVIII and TAFI in vascular remodeling after joint bleeding. Excessive vascular remodeling and vessel enlargement persisted in FVIII-deficient and TAFI-deficient mice, but not in transient hemophilia WT mice, after similar joint bleeding. TAFI-overexpression in FVIII-deficient mice prevented abnormal vessel enlargement and vascular leakage. Age-related vascular changes were observed with FVIII or TAFI deficiency and correlated positively with bleeding severity after injury, supporting increased vascularity as a major contributor to joint bleeding. Antibody-mediated inhibition of uPA also prevented abnormal vascular remodeling, suggesting that TAFI's protective effects include inhibition of uPA-mediated plasminogen activation. In conclusion, the functional TAFI deficiency in hemophilia drives maladaptive vascular remodeling in the joints after bleeding. These mechanistic insights allow targeted development of potentially new strategies to normalize vascularity and control rebleeding in HA.
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Affiliation(s)
- Tine Wyseure
- Deptartment of Molecular Medicine, The Scripps Research Institute, La Jolla, California, USA
| | - Tingyi Yang
- Deptartment of Molecular Medicine, The Scripps Research Institute, La Jolla, California, USA
| | - Jenny Y. Zhou
- Department of Medicine, UCSD, San Diego, California, USA
| | - Esther J. Cooke
- Deptartment of Molecular Medicine, The Scripps Research Institute, La Jolla, California, USA
- Department of Medicine, UCSD, San Diego, California, USA
| | - Bettina Wanko
- Division of Hematology, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
- Clinical Division of Endocrinology and Metabolism, Department of Medicine III, Medical University Vienna, Vienna, Austria
| | - Merissa Olmer
- Deptartment of Molecular Medicine, The Scripps Research Institute, La Jolla, California, USA
| | - Ruchi Agashe
- Deptartment of Molecular Medicine, The Scripps Research Institute, La Jolla, California, USA
| | - Yosuke Morodomi
- Deptartment of Molecular Medicine, The Scripps Research Institute, La Jolla, California, USA
| | - Niels Behrendt
- The Finsen Laboratory, Rigshospitalet/Biotech Research and Innovation Centre (BRIC), University of Copenhagen, Copenhagen, Denmark
| | - Martin Lotz
- Deptartment of Molecular Medicine, The Scripps Research Institute, La Jolla, California, USA
| | - John Morser
- Division of Hematology, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Annette von Drygalski
- Deptartment of Molecular Medicine, The Scripps Research Institute, La Jolla, California, USA
- Department of Medicine, UCSD, San Diego, California, USA
| | - Laurent O. Mosnier
- Deptartment of Molecular Medicine, The Scripps Research Institute, La Jolla, California, USA
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14
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Lanza E, Muglia R, Solbiati LA, Tramarin M, Poretti D, Pedicini V. Emergency Transarterial Embolization in Postoperative Hip Bleeding: Indications, Techniques, and Results in a Retrospective Cohort. J Arthroplasty 2018; 33:2273-2278. [PMID: 29544971 DOI: 10.1016/j.arth.2018.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 01/31/2018] [Accepted: 02/05/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The aim of this study is to report the results of transarterial embolization (TAE) in the setting of postoperative bleeding after hip surgery. METHODS We retrospectively evaluated 40 patients (male:female = 15:25, median age = 68 years) who underwent TAE from 2006 to 2016: 77.5% underwent total hip arthroplasty, 20% open reduction internal fixation, and 2.5% external fixation. Preangiographic multidetector computed tomography angiography was performed in 20 (49%) cases, and 9 of them showed arterial extravasation. Twenty-seven TAEs were performed within a week from surgery; active bleeding was seen in 33 (80.5%) angiograms. Gelatin sponge, microparticles, coils, n-butyl cyanoacrylate, and combinations of them were used as embolic materials. RESULTS Bleeding was controlled in all cases. The most frequently embolized arteries were branches of the deep femoral artery (n = 17). Permanent embolization agents (microparticles, coils, n-2-butyl-cyanoacrylate) were used in 88% of cases; temporary agents (gelfoam) in 12%. One procedure was complicated by arterial dissection. Hospital discharge averaged 20 days post-TAE (median = 17, range = 3-104). One-month survival rate was 97.5%. One patient died of ischemic bowel perforation. CONCLUSION TAE is safe and effective in stopping the bleeding of the hip region and should be performed early, to avoid irreversible ischemic damage. Multidetector computed tomography angiography can be used to confirm doubtful evidence of ongoing bleeding. Several embolic materials can be used, each one offering different advantages. Low complication and mortality rates were observed. TAE seems to be the ideal first-line intervention when postoperative bleeding of the operated hip is detected.
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Affiliation(s)
- Ezio Lanza
- Department of Diagnostic and Interventional Radiology, Humanitas Research Hospital, Rozzano, Milano, Italy
| | - Riccardo Muglia
- Department of Diagnostic and Interventional Radiology, Humanitas Research Hospital, Rozzano, Milano, Italy; Humanitas University, Residency Program in Radiology, Pieve Emanuele, Milano, Italy
| | | | - Marco Tramarin
- Department of Diagnostic and Interventional Radiology, Humanitas Research Hospital, Rozzano, Milano, Italy
| | - Dario Poretti
- Department of Diagnostic and Interventional Radiology, Humanitas Research Hospital, Rozzano, Milano, Italy
| | - Vittorio Pedicini
- Department of Diagnostic and Interventional Radiology, Humanitas Research Hospital, Rozzano, Milano, Italy
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15
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van Baardewijk LJ, Hoogeveen YL, van der Geest ICM, Schultze Kool LJ. Embolization of the Geniculate Arteries Is an Effective Treatment of Recurrent Hemarthrosis Following Total Knee Arthroplasty That Can Be Safely Repeated. J Arthroplasty 2018; 33:1177-1180.e1. [PMID: 29224993 DOI: 10.1016/j.arth.2017.11.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 10/09/2017] [Accepted: 11/03/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Recurrent hemarthrosis is a late complication in up to 1.6% of patients following total knee arthroplasty (TKA). In the absence of intrinsic coagulopathy, one etiology is bleeding of hypertrophic vascular synovium. The aim of this study is to evaluate the clinical outcome of patients referred to our center for angiographic embolization of geniculate arteries for recurrent hemarthrosis following TKA. METHODS We retrospectively studied a cohort of patients who were referred for geniculate artery embolization following TKA between August 2011 and September 2016. RESULTS A total of 24 embolization procedures were performed on 14 patients. Seven (50%) of these 14 patients underwent one embolization procedure. Due to symptom recurrence, 4 patients underwent a repeated procedure and 3 patients a third procedure. All embolization procedures were technically successful at the time of the procedure. Two patients reported an inguinal hematoma that healed without further treatment. At follow-up of mean 26.8 months, clinical success was achieved in 12 of the 14 patients (86%). CONCLUSION Embolization of the geniculate arteries in our study was a safe and effective treatment of recurrent spontaneous hemarthrosis following TKA. Although we have performed a substantial number of reinterventions, results of this study show that this procedure can be safely repeated without adverse events. Our results indicate that embolization could possibly be the treatment of choice when conservative measures fail and can be repeated in the event of recurrent or persistent symptoms.
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Affiliation(s)
- Laurens J van Baardewijk
- Division of Interventional Radiology, Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Yvonne L Hoogeveen
- Division of Interventional Radiology, Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Leo J Schultze Kool
- Division of Interventional Radiology, Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands
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