Spontaneous Recurrent Hemarthrosis Post Total Knee Arthroplasty Treated with Selective Embolization – A Case Report and Review of Literature

INTRODUCTION: Spontaneous recurrent hemarthrosis of the knee following a total knee arthroplasty is a rare complication with varying time of onset from 2 months to 18 years. It needs a prompt diagnosis and treatment to prevent complications of stiffness, chronic pain, and limited function. We present a case of spontaneous recurrent hemarthrosis presenting at 3 months following a total knee arthroplasty with a follow-up to 1 year. CASE REPORT: A 66-year-old male presented at 3 months following a right total knee arthroplasty with a history of increased pain and swelling of the knee joint. Initially, he was treated with anti-inflammatories when the pain and swelling recurred, an aspiration demonstrated hemarthrosis of the knee. Further evaluation demonstrated no infection, a femoral angiography demonstrated prominence of medial superior and inferior geniculate arteries with a tumor blush appearance. Therapeutic embolization of both the arteries resulted in complete resolution of the symptoms in 1 month with return of full knee function. At the end of 1-year follow-up, the patient had return of full knee function with no pain and no recurrence. CONCLUSION: An algorithmic approach is helpful in identifying the etiology of spontaneous recurrent hemarthrosis of knee and a course of conservative treatment should always be the first line of treatment. Angiography and selective arterial embolization of the geniculate arteries can be an effective treatment in the management of recurrent spontaneous hemarthrosis.