Endovascular Management of Recurrent Spontaneous Hemarthrosis After Arthroplasty

• Published in: Cardiovascular and interventional radiology Vol. 40; no. 2; pp. 216 - 222
• Main Authors: Kolber, Marcin K., Shukla, Pratik A., Kumar, Abhishek, Zybulewski, Adam, Markowitz, Todd, Silberzweig, James E.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.02.2017; Springer Nature B.V
• Subjects: Adult; Aged; Aged, 80 and over; Angiography; Arthroplasty, Replacement, Hip - adverse effects; Arthroplasty, Replacement, Knee - adverse effects; BONE JOINTS; Cardiology; Clinical Investigation; Embolization, Therapeutic - methods; Endovascular Procedures - methods; Female; Hemarthrosis - diagnostic imaging; Hemarthrosis - etiology; Hemarthrosis - therapy; HEMOPHILIA; Humans; Imaging; INFLAMMATION; INFORMATION; Male; MATERIALS; Medicine; Medicine & Public Health; Middle Aged; Nuclear Medicine; PATIENTS; PROSTHESES; Radiology; RADIOLOGY AND NUCLEAR MEDICINE; RECOMMENDATIONS; Recurrence; REVIEWS; SAFETY; SKELETAL DISEASES; Ultrasound; VASCULAR DISEASES; Hemarthrosis; Embolization; Arthroplasty
• ISSN: 0174-1551; 1432-086X
• DOI: 10.1007/s00270-016-1511-2

Purpose Recurrent spontaneous hemarthrosis is an infrequent but debilitating late complication of joint replacement, affecting up to 1.6% of patients with arthroplasty of the affected joint. Repeated episodes of bleeding result in an inflammatory cascade that further propagates bleeding events. Open and arthroscopic synovectomy are often performed when conservative treatments fail. Transarterial embolization is increasingly utilized as a less invasive option; however, its role is not widely established. We performed a systematic literature review to report the safety and efficacy of transarterial embolization in treating recurrent hemarthrosis in the setting 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, Embase, and SCOPUS databases of patients undergoing embolization for recurrent hemarthrosis after arthroplasty. Patients immediately post-operative, those embolized at first bleeding episode, and those with hemophilia were excluded. Demographic data, clinical information, angiographic findings, treatment, and outcomes were tabulated. Results The search identified 119 titles of which 24 were deemed relevant, comprising 91 patients undergoing 99 embolization procedures. Mean time from prosthesis implantation was 32.2 months. Technical success was 99%. Mean follow-up time was 24.9 months. There were 10 recurrences (10%). Two cases were complicated by joint infection requiring arthroplasty revision. Conclusions Transarterial embolization for recurrent spontaneous hemarthrosis may be safe and effective in patients having undergone arthroplasty of the affected joint.