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DOI: 10.1055/s-0045-1809563
Successful Genicular Artery Embolization for Persistent Post–Total Knee Replacement Synovitis in a Patient with Well-Controlled Rheumatoid Arthritis
Purpose or Learning Objective: Genicular artery embolization has demonstrated promising outcomes in osteoarthritic knee pain management. However, its application in post–total knee replacement synovitis remains unexplored, particularly in patients with inflammatory arthritis. This is the first documented case of genicular artery embolization for persistent post–total knee replacement synovitis in a patient with well-controlled rheumatoid arthritis.
Methods or Background: A 71-year-old woman with seronegative rheumatoid arthritis developed persistent synovitis following right total knee replacement despite well-controlled rheumatoid arthritis. Conservative management failed to provide relief, and normal inflammatory markers excluded active rheumatoid flare. Initial imaging revealed synovial thickening (6 mm) with hypervascularity. Genicular artery embolization was performed through selective catheterization of genicular arteries, targeting abnormal synovial blood vessels.
Results or Findings: The procedure achieved both technical and clinical success. A 4-month follow-up ultrasound demonstrated synovial thickness reduction from 6 mm to 3 mm, with corresponding decreases in synovial enhancement on magnetic resonance imaging. Clinical improvement was marked by a substantial reduction in pain and swelling, with a resolution of effusion and normalized gait pattern. No adverse events or changes to rheumatoid arthritis management occurred.
Conclusion: This case establishes genicular artery embolization as a promising option for post–total knee replacement synovitis in controlled inflammatory arthritis. Documented synovial thickness reduction provides evidence that targeting abnormal vasculature can effectively modulate inflammation in the post-arthroplasty environment. These findings warrant future trials to define optimal patient selection criteria and evaluate long-term outcomes in this specific population.
No conflict of interest has been declared by the author(s).
Publication History
Article published online:
02 June 2025
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