Recurrent Hemarthrosis in a Hemophilic Patient After Revision Total Knee Arthroplasty

Abstract

Recurrent hemarthrosis following a revision total knee arthroplasty is a rare complication. The likelihood of encountering bleeding complications in patients with hemophilia C following major surgery is unpredictable. Although the use of postoperative chemotherapeutic agents to prevent deep venous thrombosis (DVT) is considered the standard of care for most patients, its use in the hemophiliac population is unknown. This case describes a woman with Hemophilia C who presented with recurrent hemarthrosis 9 days after her revision total knee arthroplasty. Initial treatment efforts were directed towards treating the patient's underlying coagulopathy. Repeated transfusions of fresh frozen plasma and desmopressin were given in an attempt to achieve hemostasis. However the hemarthrosis did not resolve and 36 days postoperatively, a pseudoaneurysm of the left superior geniculate artery was found by angiography and percutaneously embolized. This article presents the first case, to our knowledge, of recurrent hemarthrosis in a hemophiliac patient after revision total knee arthroplasty. It further highlights the importance of considering all possible causes of postoperative bleeding to make a timely diagnosis in the face of a confounding clinical picture.

Revision Knee Arthroplasty in Patients with Inherited Bleeding Disorders: A Single-Center Experience

“…We therefore agree with Kickuth et al [36] and Rodriguez-Merchan et al [35] and recommend cost-effective early angiographic embolization as a treatment option. The role of prompt diagnostics and treatment was emphasized by some authors [35–42], and others [42,43] recommended routine pre-operative angiography or other diagnostics for the detection of vascular complications.…”

Pseudoaneurysms in haemophilia

“…Park et al [10] described a woman with factor XI deficiency who presented with recurrent haemarthrosis 9 days after her revision total knee arthroplasty. Initial treatment efforts were directed towards treating the patient's underlying coagulopathy.…”

Risks and challenges of orthopaedic invasive interventions in haemo -philia in a low-resource country

“…But the prevalence of complications was overwhelmingly higher in major interventions, though fortunately with no severe expression. Bleeding rate was higher than previously reported (18)(19)(20)(21), representing a risk factor for the future of the joint (infection, loosening of the prosthesis) (9,22). The most challenging complication was the development of inhibitors in PwH preoperatively not considered for this situation, imposing the change of replacement therapy to a prohibitive therapy, difficult to access because of the costs (22).…”

“…Patients and methods: Our descriptive observational retrospective study included 131 invasive surgical procedures, performed on 76 consecutive patients, most of them (93.4%) with severe disease, treated in Timisoara's Haemophilia Center over a period of 12 years; 17.1% had pre-operation anti-FVIII inhibitors. Invasive elective procedures were predominant (90.8%) as compared to emergency measures (9.2%); according to their invasiveness, 20.6% of interventions were major, 44.3% intermediate and 35.1% minor. Results were good in the majority of cases; significantly reduced joint bleed rate and pain score were the most consistent achievements.…”