Embolization for intractable spontaneous hemarthrosis of the knee joint in the elderly patient

Abstract

Rationale: Several case reports about the diagnostic and therapeutic approaches of hemarthrosis after total knee arthroplasty using angiogram have been reported, owing to the probability of bleeding caused by vascular injuries. However, there were only few cases of spontaneous hemarthrosis of the knee joint in the elderly patient that have not undergone total knee arthroplasty that have been previously reported. Patients concerns: An 82-year-old male presented to our outpatient department with acute left knee pain. He had no history of trauma. The patient had under gone several times of therapeutic arthrocentesis for treatment of left knee joint effusion at a local clinic. Diagnosis: Arthroscopic examination was performed at the local clinic and was not able to reveal any focus of intra-articular bleeding. We consulted this case with the department of radiology to angiographically find out abnormalities of the genicular arteries. Angiographs showed hyper vascularity of the superior and inferior lateral genicular artery, and superior medial genicular artery. Intervention: One-step embolization using micro-catheter and 50 to 150 μm gelfoam particles was conducted. The hypervascular findings shown on angiogram were markedly subsided after embolization. Outcomes: Until 1 year after embolization, there were no signs of recurrence on outpatient follow-up sessions Lessons: Degenerative changes of the genicular arteries may be a cause of spontaneous knee joint hemarthrosis in the elderly patients. Angiographic diagnosis and treatment may be effective for such cases.

MR imaging findings for differentiating nonhemophilic hemosiderotic synovitis from diffuse-type tenosynovial giant cell tumor of the knee

“…Lateral meniscus tear is less common than medial meniscus tear, because the lateral meniscus is more mobile than the medial meniscus, owing to its looser connections to the capsule and ligaments. However, spontaneous recurrent hemarthrosis has been reported to be a pathologic condition in elderly individuals, which results in recurrent hemarthrosis of the knee joint associated with lateral-dominant osteoarthritis and/or lateral meniscal injury [20][21][22]. The reason for this may be the location and size of the genicular arteries, which supply blood to the meniscus [20].…”

Recurrent Hemarthrosis Secondary to Erosive Patellofemoral Arthritis Treated with Arthroplasty

“…S pontaneous hemarthrosis of the knee joint in the elderly population is a rare phenomenon 16 and is mostly seen in those with OA 17 . The identified causes of spontaneous hemarthrosis in this demographic include subchondral bone bleeding, meniscal tear, genicular artery bleeding, and the use of anticoagulants 16 . Hemarthrosis caused by isolated PF bleeding, as in this case series, has been rarely documented and poorly described.…”

“…These studies have identified genicular artery or synovial bleeding as the cause of spontaneous hemarthrosis in the elderly population with OA 16,17,23 . Less has been documented about bleeding resulting from the eroded subchondral bone.…”

Effects of Acceleration on Skill Level in Skiers

“…We extensively solicited their opinions and suggestions on the author's research ideas, research methods, test plans and design of details. 8…”