Genicular Artery Embolization for Refractory Hemarthrosis following Total Knee Arthroplasty: Technique, Safety, Efficacy, and Patient-Reported Outcomes

• Published in: Journal of vascular and interventional radiology Vol. 32; no. 8; pp. 1128 - 1135
• Main Authors: Cornman-Homonoff, Joshua, Kishore, Sirish A., Waddell, Bradford S., Kesler, Jacqueline, Mandl, Lisa A., Westrich, Geoffrey H., Potter, Hollis G., Trost, David W.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-08-2021
• Subjects: MR; GAE; TKA; total knee arthroplasty; Genicular artery embolization; recurrent hemarthrosis
• ISSN: 1051-0443; 1535-7732
• DOI: 10.1016/j.jvir.2021.04.020

To investigate the safety and efficacy of genicular artery embolization for treatment of refractory hemarthrosis following total knee arthroplasty.
Patients who underwent genicular artery embolization with spherical embolics between January 2010 and March 2020 at a single institution were included if they had undergone total knee arthroplasty and subsequently experienced recurrent hemarthrosis. Technical success was defined as the significant reduction or elimination of the hyperemic blush. Clinical success was defined as the absence of clinical evidence of further hemarthrosis. Clinical follow-up was performed 7–14 days after the procedure and at 3-month intervals thereafter via a telephone interview. A total of 117 embolizations, comprising 82 initial, 28 first repeat, and 7 second repeat, were performed.
An average of 2.5 arteries was treated per procedure. The superior lateral genicular artery was the most frequently embolized. The most utilized embolic size was 100–300 μm. Follow-up was available for all patients, with a median duration of 21.5 months. 65.9%, 25.6%, and 8.5% of patients underwent 1, 2, and 3 treatments, respectively. Complications occurred following 12.8% of treatments, of which the most common was transient cutaneous ischemia. Technical success was achieved in all cases. Clinical success was achieved in 56%, 79%, and 85% of patients following the first, second, and third treatment, respectively. 83% of patients reported being either satisfied or very satisfied with the overall result.
Targeted genicular artery embolization with spherical embolics is an effective treatment for recurrent hemarthrosis with infrequent serious complications. Repeat embolization should be considered in cases of recurrence following initial therapy.