Angiographic findings and therapeutic embolization of late hemarthrosis after total joint arthroplasty

• Published in: Skeletal radiology Vol. 38; no. 1; pp. 31 - 36
• Main Authors: Dhondt, E., Vanhoenacker, F. M., d’ Archambeau, O., Snoeckx, A., Defreyne, L.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 2009; Springer; Springer Nature B.V
• Subjects: Aged; Aged, 80 and over; Angiography, Digital Subtraction; Arthroplasty, Replacement; Biological and medical sciences; Cardiovascular system; Embolization, Therapeutic - methods; Female; Hemarthrosis - diagnostic imaging; Hemarthrosis - therapy; Humans; Imaging; Investigative techniques, diagnostic techniques (general aspects); Joint surgery; Male; Medical imaging; Medical sciences; Medicine & Public Health; Nuclear Medicine; Orthopedic surgery; Orthopedics; Osteoarticular system. Muscles; Pathology; Postoperative Complications - diagnostic imaging; Postoperative Complications - therapy; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Radiology; Retrospective Studies; Scientific Article; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Hemarthrosis; Total joint arthroplasty; Embolization; Nuclear medicine; Radiodiagnosis; Angiography; Prosthesis; Orthopedics; Radiology; Instrumentation therapy; Joint; Traumatology
• ISSN: 0364-2348; 1432-2161
• DOI: 10.1007/s00256-008-0569-6

Objective
The objective of this study was to describe the angiographic findings of late spontaneous hemarthrosis after total joint arthroplasty and to illustrate the therapeutic role of angiography.
Materials and methods
A retrospective multicenter study was performed looking for patients who underwent an angiography for spontaneous hemarthrosis occurring at least 1 month after total joint arthroplasty. Eight patients were included, all suffering from spontaneous hemarthrosis. One patient had an additional large extra-articular hematoma.
Results
Angiography in eight cases revealed hypertrophic vascular synovium in seven patients with an additional false aneurysm in one patient. Hypervascularization with pooling of contrast spots was seen in one patient. Five patients underwent selective arterial particulate embolization. Three patients were successfully embolized after one session, one was successful after two sessions, and one patient needed surgery after two embolization sessions.
Conclusion
Angiography for late spontaneous hemarthrosis is very effective to exclude or establish vascular malformations and to establish the diagnosis of hypertrophic vascular synovium. Selective arterial embolization seems to be a good therapeutic option as alternative to open or arthroscopic synovectomy.