Recurrent hemarthrosis in a hemophilic patient after revision total knee arthroplasty.
Recurrent hemarthrosis following a revision total knee arthroplasty is a rare complication. The likelihood of encountering bleeding complications in patients with hemophilia C following major surgery is unpredictable. Although the use of postoperative chemotherapeutic agents to prevent deep venous thrombosis (DVT) is considered the standard of care for most patients, its use in the hemophiliac population is unknown. This case describes a woman with Hemophilia C who presented with recurrent hemarthrosis 9 days after her revision total knee arthroplasty. Initial treatment efforts were directed towards treating the patient's underlying coagulopathy. Repeated transfusions of fresh frozen plasma and desmopressin were given in an attempt to achieve hemostasis. However the hemarthrosis did not resolve and 36 days postoperatively, a pseudoaneurysm of the left superior geniculate artery was found by angiography and percutaneously embolized. This article presents the first case, to our knowledge, of recurrent hemarthrosis in a hemophiliac patient after revision total knee arthroplasty. It further highlights the importance of considering all possible causes of postoperative bleeding to make a timely diagnosis in the face of a confounding clinical picture.
Division of Orthopedic Surgery, New York University Hospital for Joint Diseases, New York, New York 10003, USA. justin.park@ nyumc.org
Justin J
JJ
Park
James D
JD
Slover
Steven A
SA
Stuchin
D000328:Adult; D017541:Aneurysm, False / Q000209:etiology / Q000473:pathology / Q000601:surgery; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D004621:Embolization, Therapeutic; D005173:Factor XI Deficiency / Q000473:pathology* / Q000601:surgery; D005260:Female; D006395:Hemarthrosis / Q000209:etiology / Q000473:pathology* / Q000601:surgery; D006801:Humans; D007719:Knee Joint / Q000098:blood supply / Q000473:pathology*; D011183:Postoperative Complications; D012008:Recurrence; D016896:Treatment Outcome