A case of selective arterial embolization for recurrent hemarthrosis after total knee arthroplasty

Traditional investigation and management for recurrent hemarthrosis after total knee arthroplasty: A case report

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.

The results of Oxford unicompartmental knee arthroplasty in the United States: a mean ten-year survival analysis

Aims

Approved by the Food and Drug Administration in 2004, the Phase III Oxford Medial Partial Knee is used to treat anteromedial osteoarthritis (AMOA) in patients with an intact anterior cruciate ligament. This unicompartmental knee arthroplasty (UKA) is relatively new in the United States, and therefore long-term American results are lacking.

Patients and Methods

This is a single surgeon, retrospective study based on prospectively collected data, analysing a consecutive series of primary UKAs using the Phase III mobile-bearing Oxford Knee and Phase III instrumentation.

Between July 2004 and December 2006, the senior author (RHE) carried out a medial UKA in 173 patients (213 knees) for anteromedial osteoarthritis or avascular necrosis (AVN).

A total of 95 patients were men and 78 were women. Their mean age at surgery was 67 years (38 to 89) and mean body mass index 29.87 kg/m2 (17 to 62).

The mean follow-up was ten years (4 to 11).

Results

Survivorship of the Oxford UKA at ten years was 88%, using life table analysis. Implant survivorship at ten years was 95%. The most common cause for revision was the progression of osteoarthritis in the lateral compartment. The mean knee score element of the American Knee Society Score (AKSS) was 50 pre-operatively and increased to 93 post-operatively. The mean AKSS function score was 56 pre-operatively rising to 78 post-operatively

Conclusion

This ten-year follow-up study of the Oxford UKA undertaken in the United States shows good survivorship and excellent function in a wide selection of patients with AMOA and AVN.

Cite this article: Bone Joint J 2016;98-B(10 Suppl B):34–40.

Recurrent Hemarthroses After TKA Treated With an Intraarticular Injection of Yttrium-90

BACKGROUND

Recurrent hemarthroses after a TKA are uncommon and usually respond to nonoperative treatment or intervention using angiographic embolization or synovectomy. However, in rare circumstances, the problem can be resistant to treatment.

CASE DESCRIPTION

We report the case of a patient who had recurrent hemarthroses after a TKA. During the first 18 months after surgery, the patient experienced 48 episodes consistent with bleeding into the knee. The bleeding episodes recurred despite use of traditional treatments, including arthroscopy, open synovectomy and embolization of a small, false aneurysm. The patient ultimately received an intraarticular injection of yttrium-90 silica/citrate, and the hemarthroses ceased soon after the injection. At last review, 25 months after the injection, the patient had experienced no additional bleeding episodes.

LITERATURE REVIEW

On review of the literature, we found only one other report in which yttrium-90 was used successfully in a similar situation.

CLINICAL RELEVANCE

Yttrium-90 may be considered a treatment option in patients with recurrent hemarthroses after TKA, especially when the condition has not responded to more traditional treatments. The long-term risk of treatment with yttrium-90 for recurrent hemarthroses after a TKA remains unclear.