Geniculate Embolization

Hemarthrosis

Hemarthrosis is when there is bleeding into the knee joint cavity. Pain, tenderness, redness, swelling, warmth, and stiffness in the affected joint are some of the symptoms. Bruising may be visible in the area around the joint.

Postoperative hemarthrosis most commonly occurs after arthroscopic surgery, such as a total knee replacement. Recurrent hemarthrosis occurs in about 0.3% of people who have had a total knee replacement. Repetitive trauma and inflamed hypervascular synovial tissue causes bleeding in the joint. Typically, these joints are aspirated yielding bloody fluid. Some patients however do not respond well to conservative measures and experience continued bleeding into the joint. Hemarthrosis embolization is an option for those who need a more permanent solution.

Blood thinners, osteoarthrosis, hemophilia, and malignancies in the joint are also other potential causes of hemarthrosis.

Why Treat Hemarthrosis

After knee replacement surgery, if hemarthrosis develops and the patient does not receive treatment, the joint can be further damaged causing stiffness and loss of range of motion. This can lead to muscular weakening as well. Infection of the joint can occur as well.

Current Treatments for Hemarthrosis

Ice and rest of the joint, elevation of the leg, and pain medication are typically first line treatments. This may be all that is required for patients in some cases.

Aspiration, surgical excision of the synovial tissue, or embolization can also be used to treat recurrent hemarthrosis. If a patient fails conservative management and aspiration, embolization procedure may be explored as a minimally invasive option.

Embolization

During an embolization, the blood supply to a specific location is cut off. Geniculate artery embolization specifically cuts off the blood supply to the inflamed tissues of the knee joint.

The geniculate arteries extend into the knee joint and can cause sporadic bleeding or pain if inflamed and are frequently the source of the problem.

Geniculate Artery Embolization: Procedure

Embolization is an outpatient non-surgical procedure with a short recovery. The patient is given a mild sedative and a local topical anesthetic to help numb the skin. A tiny catheter is inserted and guided to the knee using an x-ray system that provides moving photographs in “real time.”

Embolism of the geniculate artery is completed by injecting sand-sized particles into the catheter. The blood arteries become blocked with the particles, resulting in a lack of blood flow to the abnormal tissues of the joint reducing inflammation and pain.^8,9

Patients are discharged one to two hours after the treatment, and pain relief typically begins within two weeks. As the procedure is minimally invasive, the incidence of any complications is very low. Patients might experience bruising or pain at the injection site. Some rare complications for GAE include allergic reactions, infection, bleeding/bruising, skin irritation.

Geniculate Artery Embolization: Results

Current data shows promising results in relieving osteoarthritis. There was a 61% and 67% drop in WOMAC and VAS pain levels, respectively, throughout a 12-month period in research.⁵ Clinical investigations have revealed that after GAE, pain is significantly reduced. The demand for medications such as analgesics was also reduced. There were also no major adverse effects or complications during or following the treatment, according to the research.⁷

For hemarthrosis, embolization has a technical success rate over 90%. After 26.8 months of follow-up, the clinical success rate is 89%, which means that 89% of patients are symptom-free.