Severe postoperative haemarthrosis following a total knee replacement in a haemophiliac patient caused by a pseudoaneurysm: early treatment with arterial embolization

Rodríguez-Merchán, E. Carlos; Jiménez‐Yuste, Víctor; Gómez-Cardero, Primitivo; Rodríguez, T.

doi:10.1111/hae.12286

Cited by 10 publications

(7 citation statements)

References 9 publications

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“…In one of our patients (case 4), thrombin injections were repeated three times without success, but complete obliteration was achieved with endovascular coiling technique. 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.…”

Section: Discussionsupporting

confidence: 91%

“…The treatment options for the first condition comprise intensive clotting factor replacement therapy, ultrasound-guided injection of thrombin, ultrasound-guided compression, selective angiographic embolization, and open vascular repair with resection of the pseudo-aneurysm and interposition grafting [35]. To our knowledge, to date, only eight cases of aneurysm following primary TKA [35–40] and one following revision TKA [41] have been reported in patients with hemophilia. Saarela et al [38] applied local thrombin as treatment and obtained a satisfactory result, whereas in other reports, angiographic embolization was successfully performed.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2017

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BackgroundThe results of total knee arthroplasty (TKA) in patients with inherited bleeding disorders (IBDs) are poorer when compared with those in the general population, with a notably higher risk of complications and higher revision rates. Thus, revision procedures are becoming a growing concern in this group of patients. The aim of this study was to evaluate the results of revision TKA in patients with IBD.Material/MethodsA retrospective cohort study with longitudinal assessment of hemophilia patients scheduled for revision TKA between January 2010 and September 2015 was performed. The clinical status of the patients was assessed based on the Knee Society Score, and the Numeric Rating Scale was used to assess knee pain severity and patient satisfaction with the surgery. Radiological examination, post-operative complications, and reinterventions were recorded and analyzed.ResultsVery good results were obtained in all patients treated for aseptic loosening of the implant. However, inferior results were found in cases with infection. All patients operated on for aseptic loosening required only single-stage TKA, whereas patients with infection underwent multiple interventions. Complications were observed only in cases with infection.ConclusionsOur study clearly outlined the differences in results based on failure mode, with far inferior results obtained in cases with infection. Given the lack of data in this area as well as the high specificity of this population, further high-quality studies are needed.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

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

et al. 2017

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“…The surgery is preferred to be performed under general anesthesia, tourniquet use until wound closure (100), capsule infiltration with a mixed solution, and tranexamic acid injection following capsule closure (101,102). Moreover, hemostasis equilibrium is needed to prevent pseudoaneurysm postoperatively (103,104).…”

Section: Surgical Interventions For the Hemophilic Patientmentioning

confidence: 99%

Current therapeutic approaches in the management of hemophilia—a consensus view by the Romanian Society of Hematology

et al. 2021

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Hemophilia A (HA) and hemophilia B (HB) are rare disorders, being caused by the total lack or under-expression of two factors from the coagulation cascade coded by genes of the X chromosome. Thus, in hemophilic patients, the blood does not clot properly. This results in spontaneous bleeding episodes after an injury or surgical intervention. A patient-centered regimen is considered optimal. Age, pharmacokinetics, bleeding phenotype, joint status, adherence, physical activity, personal goals are all factors that should be considered when individualizing therapy. In the past 10 years, many innovations in the diagnostic and treatment options were presented as being either approved or in development, thus helping clinicians to improve the standard-of-care for patients with hemophilia. Recombinant factors still remain the standard of care in hemophilia, however they pose a challenge to treatment adherence because they have short halflife, which where the extended half-life (EHL) factors come with the solution, increasing the half-life to 96 hours. Gene therapies have a promising future with proven beneficial effects in clinical trials. We present and critically analyze in the current manuscript the pros and cons of all the major discoveries in the diagnosis and treatment of HA and HB, as well as identify key areas of hemophilia research where improvements are needed.

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“…An arterial embolization of the pseudoaneurysm must then be performed immediately using a helical microcoil. 38…”

Section: Treatment Of Arthropathymentioning

confidence: 99%

The role of orthopaedic surgery in haemophilia: current rationale, indications and results

Rodríguez-Merchán¹

2019

EFORT Open Reviews

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The musculoskeletal problems of haemophilic patients begin in infancy when minor injuries lead to haemarthroses and haematomas. Early continuous haematological primary prophylaxis by means of the intravenous infusion of the deficient coagulation factor (ideally from cradle to grave) is of paramount importance because the immature skeleton is very sensitive to the complications of haemophilia: severe structural deficiencies may develop quickly. If primary haematological prophylaxis is not feasible due to expense or lack of venous access, joint bleeding will occur. Then, the orthopaedic surgeon must aggressively treat haemarthrosis (joint aspiration under factor coverage) to prevent progression to synovitis (that will require early radiosynovectomy or arthroscopic synovectomy), recurrent joint bleeds, and ultimately end-stage osteoarthritis (haemophilic arthropathy). Between the second and fourth decades, many haemophilic patients develop articular destruction. At this stage the main possible treatments include arthroscopic joint debridement (knee, ankle), articular fusion (ankle) and total joint arthroplasty (knee, hip, ankle, elbow).Cite this article: EFORT Open Rev 2019;4:165-173. DOI: 10.1302/2058-5241.4.180090

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Severe postoperative haemarthrosis following a total knee replacement in a haemophiliac patient caused by a pseudoaneurysm: early treatment with arterial embolization

Cited by 10 publications

References 9 publications

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

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

Current therapeutic approaches in the management of hemophilia—a consensus view by the Romanian Society of Hematology

The role of orthopaedic surgery in haemophilia: current rationale, indications and results

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