Abstract
Total knee arthroplasty (TKA)-associated hemarthroses are infrequent and often respond
to nonoperative therapy. Geniculate artery embolization may provide symptomatic relief
in cases recalcitrant to needle aspiration, although no meta-analysis exists regarding
this therapy. This meta-analysis aims to assess the rate of symptom relief, the number
of embolizations needed to achieve relief, and the rate of complications associated
with embolization. Public databases were queried from 1998 until 2018 for TKA-associated
recurrent hemarthroses treated with embolization. Eight studies met inclusion and
exclusion criteria. Major complications were defined as those requiring readmission
or nonelective reoperation; minor complications were defined as those not requiring
readmission or reoperation. Pooled statistics were calculated utilizing the method
of inverse variance. Fifty-nine patients with a mean follow-up of 30 months (range,
1–50 months) were evaluated. The pooled proportion of patients with symptom improvement
following embolization was 86% (95% confidence interval [CI]: 74–93%, I
2: 0%, p = 0.97). The average number of embolization procedures was 1.30 (95% CI: 1.03–1.63,
I
2: 0%, p = 0.66). The pooled proportion of patients who required a second embolization procedure
was 26% (95% CI: 15–40%, I
2: 0%, p = 0.43), while those requiring three or more procedures was 13% (95% CI: 6–25%, I
2: 0%, p = 0.87). The rate of complications were as follows: any complication – 19% (95% CI:
11–32%, I
2: 0%, p = 0.81); major complications–8% (95% CI: 3–19%, I
2: 0%, p = 0.96); minor complications–18% (95% CI: 10–31%, I
2: 0%, p = 0.79); inguinal hematoma–9% (95% CI: 4–19%, I
2: 0%, p = 1.00); skin necrosis–15% (95% CI: 7–29%, I
2: 0%, p = 0.62); and incision breakdown–7% (95% CI: 3–17%, I
2: 0%, p = 1.00). Previous literature on selective artery embolization following TKA is relatively
limited. This meta-analysis supports embolization as a potentially safe and effective
treatment for recurrent hemarthroses after TKA. Other correctable causes of recurrent
hemarthrosis, such as instability or malalignment, must be diligently ruled out prior
to utilizing embolization. Surgeons should be aware of embolization's potential role
in the postoperative period following TKA.
Keywords
total knee replacement - hemarthrosis - embolization
