Recurrent spontaneous hemarthrosis associated with reflex sympathetic dystrophy

Selective Embolization Is Safe and Effective for Total Knee Arthroplasty-Associated Recurrent Hemarthroses: A Systematic Review and Meta-Analysis

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.

Arthroscopic observation was useful to detect loosening of the femoral component of unicompartmental knee arthroplasty in a recurrent hemoarthrosis

A case of recurrent hemarthrosis of the knee after a mobile-bearing unicompartmental knee arthroplasty (UKA; Oxford UKA) is described. A 58-year-old man met with a road traffic accident 10 months after UKA. He developed anteromedial pain and hemarthrosis of the knee joint 1 month after the accident, which required multiple aspirations. Physical examination showed no instability. Plain radiograph revealed no signs of loosening. All laboratory data, including bleeding and coagulation times, were within normal limits. Diagnostic arthroscopy demonstrated loosening of the femoral component. Any intraarticular pathology other than nonspecific synovitis was ruled out. The loose femoral component and polyethylene meniscal bearing were revised. Since then, hemarthrosis has not recurred.

An unusual meniscal ganglion cyst that triggered recurrent hemarthrosis of the knee

A 58-year-old woman suffered spontaneous recurrent hemarthrosis of the knee. In the clinical course, pigmented villonodular synovitis was mostly suspected, but in arthroscopic surgery the lateral meniscus appeared to be upturned and stuck into the lateral pouch with the meniscal ganglion cyst. It was suggested that meniscal tear with meniscal ganglion cyst was related with recurrent hemarthrosis. Generally, both the meniscal ganglion cysts and spontaneous recurrent hemarthrosis are highly rare conditions. In this case, we speculated that a negligible power could induce the meniscal tear with recurrent hemarthrosis in the particular situation in which the meniscal ganglion cyst existed. In other words, the meniscal ganglion cyst might basically and physically relate with hemorrhagic condition. Arthroscopically, the meniscal ganglion cyst was removed together with the anterior segment of the lateral meniscus. Recurrent hemarthrosis was treated successfully by resection of the meniscus.