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

Abstract

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.

Embolization of the Geniculate Arteries Is an Effective Treatment of Recurrent Hemarthrosis Following Total Knee Arthroplasty That Can Be Safely Repeated

“…Open surgical synovectomy has been reported to be successful in most cases but is associated with the complications and morbidity of repeated surgery such as loss of function and infection [1,2,4]. Radiosynovectomy is a promising technique; however, this is only documented in case reports [5]. Embolization of geniculate arteries has been reported in small series of patients and is considered a minimally invasive treatment with good clinical success and a low complication rate [3,6].…”

Recurrent Hemarthrosis Following Total Knee Arthroplasty

“…In a case report by Kapetanos et al, the use of an intra-articular injection of yttrium-90 (Y-90) was effective in treating a recurrent hemarthrosis following total knee arthroplasty after conservative therapy and thermocoagulation failed 36 . Fine and Klestov replicated the successful use of synoviorthesis in a later case report, where Y-90 was successful in treating a refractory case of recurrent hemarthrosis that failed to respond to arthroscopic synovectomy as well as angiography 37 .…”

Recurrent hemarthrosis after total knee arthroplasty in rheumatoid arthritis successfully treated with selective embolization: A case report

“…Other single cases and case series reported recurrent hemarthrosis after TKA in patients with OA. [4][5][6][7][8][9] There were only two reports of recurrent hemarthrosis after TKA in patients with rheumatoid arthritis (RA). Ohdera et al 2 reported that recurrent hemarthrosis occurred in one (0.1%) of 625 RA patients after TKA.…”

“…Other single cases and case series reported recurrent hemarthrosis after TKA in patients with OA. 4 – 9 …”