3:09 PM Abstract No. 202 Embolization of genicular arteries for chronic hemarthrosis post knee prosthesis

Postoperative hemarthrosis after knee prosthesis can be invalidating due to painful swelling of the knee and diminished mobility. We describe the technique and clinical results of endovascular embolization of genicular arteries performed over a 10-year period. A retrospective review of 31 patients (17 male, 14 female) treated for chronic knee hemarthrosis from 01.2007 until 12.2016 was performed. The mean age was 67y (range, 48-90). A total of 39 embolization procedures were performed (24 single, 6 double and 1 triple), 27 right and 12 left sided. The mean time from surgery to symptoms was 24,4 months (range, 1-64) and to embolization was 27,4 months (range, 1-70). Surgery type was total-knee prosthesis (TKP) in 29 patients, unicondylar (UC) prosthesis in 2. The mean follow-up was 61,9 months (range, 2 - 120). The technical approach was ipsilateral (antegrade femoral) in 34 procedures and contralateral in 5. All embolizations were performed using 4F diagnostic catheters, 2.7F microcatheters and microspheres ranging from 100 - 500μ. The technical endpoint was subtotal devascularization in order to avoid ischemic complications. Clinical endpoint was symptomatic improvement. Technical success was achieved 100%. In all cases, the superior lateral and medial genicular arteries could be embolized. In 12/39 procedures (31%), one or both inferior genicular arteries could not be catheterized due to the superposition of the TKP. Embolization was then performed through collaterals. Symptomatic improvement was achieved in 26/31 patiënts (84%). Symptomatic recidive was more frequent with larger particles (up to 500μ). Postprocedural pain was observed in all patients, treated with paracetamol, resolving inside 24 hours in most. Smaller particles (100μ) resulted in more severe pain. Therefore, particular size of 250μ is preferred. Two complications occurred, one low grade infection and one aseptic necrosis requiring surgical revision. No peripheral emboli were noted. Endovascular embolization of genicular arteries is safe and effective for the treatment of chronic hemarthrosis post knee prosthesis placement. Clinical improvement is seen in most patients. Complications are rare.