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JBJS Reviews Oct 2019
Review
Topics: Algorithms; Arthroplasty, Replacement, Knee; Hemarthrosis; Humans; Postoperative Complications; Recurrence
PubMed: 31663920
DOI: 10.2106/JBJS.RVW.19.00012 -
The Journal of the American Academy of... Sep 2019Recurrent hemarthrosis (RH) is a rare complication (∼1%) after total knee arthroplasty (TKA). It is a complex and particularly frustrating problem for both patient and... (Review)
Review
Recurrent hemarthrosis (RH) is a rare complication (∼1%) after total knee arthroplasty (TKA). It is a complex and particularly frustrating problem for both patient and surgeon. Typically, patients present several months to years after their index TKA surgery with a painful and swollen joint. Although conservative management may provide temporary relief, the rate of recurrence is high. Despite extensive case series in the literature, no consensus was made on the criteria needed to establish this diagnosis, or how to best provide treatment. Several management strategies have been described for RH, including immobilization, arthroscopic versus open synovectomy, angiographic embolization, and revision arthroplasty. All of these have demonstrated variable effectiveness, with limited evidence for their use in specific situations. This review synthesizes the available literature and suggests an algorithm for the diagnosis and treatment of RH after TKA.
Topics: Arthroplasty, Replacement, Knee; Embolization, Therapeutic; Hemarthrosis; Humans; Physical Examination; Postoperative Complications; Recurrence; Reoperation; Synovectomy
PubMed: 30720569
DOI: 10.5435/JAAOS-D-18-00182 -
Expert Review of Hematology Dec 2017The management of acute hemophilic hemarthrosis (AHH) classically has consisted of factor replacement therapy and RICE (rest, ice, compression and elevation). However,... (Meta-Analysis)
Meta-Analysis Review
The management of acute hemophilic hemarthrosis (AHH) classically has consisted of factor replacement therapy and RICE (rest, ice, compression and elevation). However, there is still a controversy in the literature regarding the role of local cryotherapy (LC) in AHH. Areas covered: The aim of this article is to review the potential role of LC in AHH. Expert commentary: Some authors have reported that LC attenuates joint inflammation and has a positive influence on controlling articular swelling and temperature. However, other authors have stated that low temperature is associated with impairment of coagulation enzyme activity and platelet function. Although some reports have mentioned the benefits of LC in AHH and other have mentioned its adverse events, the data on the topic are still scant and preliminary. Literature of LC in the management of AHH is controversial. Whilst LC has always been considered as an unquestionable necessity in the management of AHH, it should be utilized with caution until a randomized study can solve the dilemma.
Topics: Cryotherapy; Disease Management; Hemarthrosis; Hemophilia A; Humans; Treatment Outcome
PubMed: 29020808
DOI: 10.1080/17474086.2017.1392236 -
Journal of Thrombosis and Haemostasis :... Sep 2021Hemophilia A and B are rare X-linked inherited bleeding disorders caused by complete or partial deficiency in or the absence of coagulation factors VIII and IX.... (Review)
Review
Hemophilia A and B are rare X-linked inherited bleeding disorders caused by complete or partial deficiency in or the absence of coagulation factors VIII and IX. Recurrent joint bleeding (hemarthrosis) is the most frequent clinical manifestation of severe hemophilia. Unless appropriately managed, even subclinical hemarthrosis can lead to the development of hemophilic arthropathy, a disabling condition characterized by joint remodelling, chronic pain, and a reduced quality of life, and eventually requires joint replacement. Given the lack of specific treatments to reduce blood-induced synovitis, the prevention of bleeding is pivotal to the maintenance of joint health. Prophylactic coagulation factor replacement therapy using extended half-life recombinant drugs has significantly improved patients' quality of life by reducing the burden of intravenous injections, and the more recent introduction of nonreplacement therapies such as subcutaneous emicizumab injections has improved treatment adherence and led to the greater protection of patients with hemophilia A. However, despite these advances, chronic arthropathy is still a significant problem. The introduction of point-of-care ultrasound imaging has improved the diagnosis of acute hemarthrosis and early hemophilic arthropathy, and allowed the better monitoring of progressive joint damage, but further research into the underlying mechanisms of the disease is required to allow the development of more targeted treatment. In the meantime, patient management should be based on the risk factors for the onset and progression of arthropathy of each individual patient, and all patients should be collaboratively cared for by multidisciplinary teams of hematologists, rheumatologists, orthopedic surgeons, and physiotherapists at comprehensive hemophilia treatment centers.
Topics: Factor VIII; Hemarthrosis; Hemophilia A; Humans; Quality of Life; Synovitis
PubMed: 34197690
DOI: 10.1111/jth.15444 -
Journal of the American Podiatry... Jun 1980
Review
Topics: Diagnosis, Differential; Hemarthrosis; Humans; Knee Joint; Radiography
PubMed: 6991586
DOI: 10.7547/87507315-70-6-283 -
La Semaine Des Hopitaux : Organe Fonde... Nov 1982The various etiologies of spontaneous hemarthrosis in adolescents and adults are reviewed: they include systemic diseases and local or regional disorders of the bones or... (Review)
Review
The various etiologies of spontaneous hemarthrosis in adolescents and adults are reviewed: they include systemic diseases and local or regional disorders of the bones or joints. Among systemic diseases, the two main causes are coagulation disorders and hemoglobinopathies. Coagulation disorders may be either acquired (leukemia, thrombopenia, and hypoprothrombinemia induced by anticoagulant drugs with hemarthrosis being one of the major complications) or inherited (hemophilia which is not considered here, von Willebrand disease, and congenital thrombopathies). Hemoglobinopathies, particularly sickle-cell disease, are responsible for hemarthrosis in a few patients. Among local or regional disorders of the bones or joints, tumors such as hemangioma or synovial sarcoma are uncommon causes. Hemarthrosis is the main feature of pigmented villonodular synovitis. Hemarthrosis may occur in degenerative and metabolic diseases: while it is extremely rare in arthritis, it is frequently encountered in articular chondrocalcinosis which is the first diagnosis to consider when hemarthrosis occurs in an elderly patient. The search for an etiology, which is often difficult, should include a review of prior illnesses, a study of coagulation, and local clinical, radiological and biological investigations, with a study of the synovial fluid; in some instances, arthroscopy, synovial biopsy and even surgical exploration are required. Management includes rest, analgesics, antiinflammatory drugs and, above all, arthrocentesis which is essential for the prevention of articular damage and functional sequellae. Specific therapy is dependent on the etiology. In recurrent hemarthrosis, isotopic synoviorthesis may ensure lasting resolution of the effusion.
Topics: Adolescent; Adult; Blood Coagulation Disorders; Cartilage Diseases; Hemarthrosis; Humans; Joint Diseases; Neoplasms; Synovial Membrane
PubMed: 6297020
DOI: No ID Found -
Journal of the Medical Association of... Jun 1992Rapid swelling of the knee following a blow or twisting injury is considered a significant injury. The history of trauma coupled with a thorough examination should... (Review)
Review
Rapid swelling of the knee following a blow or twisting injury is considered a significant injury. The history of trauma coupled with a thorough examination should provide an accurate diagnosis in most patients. Although it should not be performed routinely, aspiration of the fluid can be done to aid in making a diagnosis and to alleviate pain. Splinting and re-evaluation are recommended as the initial treatment of an acute hemarthrosis. Ancillary testing that includes x-ray films and MRIs is beneficial. Although arthroscopic evaluation of the knee is not needed in every patient with an acute hemarthrosis, a high percentage of these patients eventually undergo arthroscopy to complete the diagnosis or as a means of early surgical intervention. The decision to surgically repair an injured structure depends on the patient's age, activity level, amount of instability, and associated lesions. Routine arthroscopy is indicated as a means to determine the correct treatment and not merely for diagnosis. With knowledge of the common causes of hemarthrosis and understanding of the knee examination, a trained examiner can make an accurate diagnosis 80% to 90% of the time and prescribe the appropriate treatment.
Topics: Acute Disease; Adult; Age Factors; Athletic Injuries; Child; Hemarthrosis; Humans; Knee Injuries; Physical Examination
PubMed: 1607844
DOI: No ID Found -
Clinics in Orthopedic Surgery Jun 2021Recurrent hemarthrosis following total knee arthroplasty (TKA) is a rare complication. Its pathophysiology and standard treatments have not yet been established. In this...
BACKGROUD
Recurrent hemarthrosis following total knee arthroplasty (TKA) is a rare complication. Its pathophysiology and standard treatments have not yet been established. In this study, we report 7 cases of recurrent hemarthrosis after TKA in which failure of the initial conservative treatment was followed by angiographic embolization; in 1 of the 7 cases, arthroscopic electrocauterization was also performed after treatment failure with selective embolization.
METHODS
From January 2015 to May 2018, 7 patients visited our hospital due to recurrent hemarthrosis after TKA. Their medical records and serologic test results were reviewed to check for the presence of any bleeding disorder and history of anticoagulant use. Implant malalignment and instability were checked using X-ray. In all cases, the conservative treatment failed, so interventional angiography with selective embolization was performed, which was also followed by arthroscopic electrocauterization if the outcome was unsatisfactory.
RESULTS
The interval between TKA and the onset of hemarthrosis ranged from 3 to 76 months (average, 34.1 months). There was no coagulopathy and instability. All patients underwent conservative treatment at an interval of 4.3 months and the rate of relapse was 3.1 on average. On the interventional angiography, 6 cases showed vascular blush, and 1 case had pulsatile bleeding. The average duration for interventional angiography was 90.9 minutes. The average length of follow-up was 38.8 months. Embolization was successfully performed in 4 cases. In 2 of 3 failed cases, the symptoms improved without further treatment. In the remaining 1 failed case, the patient had a relapse of hemarthrosis, so an arthroscopic procedure was performed, which led to identification of the suspicious bleeding point by using preoperative angiographic findings. Electrocauterization was performed and active bleeding was stopped. All cases with recurrent hemarthrosis achieved improvement.
CONCLUSIONS
Interventional angiography was used to aid in the diagnosis of recurrent hemarthrosis, and therapeutic selective embolization provided satisfactory clinical results. Even if selective embolization fails, interventional angiography may be helpful for further surgical procedures because it reveals vascular blush of a bleeding site. Therefore, interventional angiography and selective embolization should be considered to be a useful treatment for recurrent hemarthrosis after TKA.
Topics: Aged; Aged, 80 and over; Angiography; Arthroplasty, Replacement, Knee; Electrocoagulation; Embolization, Therapeutic; Female; Hemarthrosis; Humans; Male; Middle Aged; Postoperative Complications
PubMed: 34094005
DOI: 10.4055/cios20066 -
Clinical Orthopaedics and Related... Oct 1997Acute hemarthroses are probably the most frequent type of bleeding in the patient with hemophilia. Delayed and/or inadequate treatment can trigger a series of pathologic... (Review)
Review
Acute hemarthroses are probably the most frequent type of bleeding in the patient with hemophilia. Delayed and/or inadequate treatment can trigger a series of pathologic changes within the joint leading to a painful and disabling arthropathy. Despite the advent of prophylactic treatment with factor concentrates, the majority of patients in the world have no access to even on demand factor replacement. Care for all patients involves a team approach led by the hematologist but including input from orthopaedic surgeons and physiotherapists. Optimal treatment involves a combination of factor replacement, rest, ice, and supervised rehabilitation. In certain cases, joint aspiration may be considered. In developing countries, where factor concentrates are in short supply, such bleeding episodes usually are treated by physical means alone or with the addition of cryoprecipitate or fresh frozen plasma. After successful resolution of such episodes by whatever means, the events leading to the bleeding episode and its subsequent management should be considered within the setting of the treating unit. Such debriefings should aim to provide counsel regarding any appropriate lifestyle modifications and, where necessary, treatment should be arranged to minimize the risk of additional episodes.
Topics: Acute Disease; Blood Coagulation Factors; Counseling; Cryotherapy; Developing Countries; Hemarthrosis; Hemophilia A; Humans; Ice; Joint Diseases; Life Style; Paracentesis; Patient Care Team; Physical Therapy Modalities; Rest; Risk Factors; Synovitis
PubMed: 9345199
DOI: No ID Found -
JBJS Case Connector Jan 2022Three patients presented with recurrent hemarthrosis secondary to erosive patellofemoral arthritis. Recurrent hemarthrosis from the eroded patellofemoral subchondral...
CASE
Three patients presented with recurrent hemarthrosis secondary to erosive patellofemoral arthritis. Recurrent hemarthrosis from the eroded patellofemoral subchondral bone has not been well described. Each patient presented with symptoms secondary to painful effusions that were identified by aspiration. Each patient was successfully treated with patellofemoral or total knee arthroplasty.
CONCLUSION
Spontaneous or recurrent effusions in the setting of erosive patellofemoral arthritis should prompt orthopaedic surgeons to consider hemarthrosis as the cause of such effusions. Patellofemoral or total knee arthroplasty is effective in resolving the hemarthroses, resolving pain, and restoring function in these patients.
Topics: Arthritis; Arthroplasty, Replacement, Knee; Hemarthrosis; Humans; Recurrence
PubMed: 35020627
DOI: 10.2106/JBJS.CC.21.00438