title: Endovascular Management of Recurrent Spontaneous Hemarthrosis After Arthroplasty.
abstract: OBJECTIVE
  Recurrent spontaneous hemarthrosis is an infrequent but debilitating late complication of joint replacement, affecting up to 1.6% of patients with arthroplasty of the affected joint. Repeated episodes of bleeding result in an inflammatory cascade that further propagates bleeding events. Open and arthroscopic synovectomy are often performed when conservative treatments fail. Transarterial embolization is increasingly utilized as a less invasive option; however, its role is not widely established. We performed a systematic literature review to report the safety and efficacy of transarterial embolization in treating recurrent hemarthrosis in the setting of prior arthroplasty.
  
  
  METHODS
  A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. A structured search was performed in PubMed, Web of Science, Embase, and SCOPUS databases of patients undergoing embolization for recurrent hemarthrosis after arthroplasty. Patients immediately post-operative, those embolized at first bleeding episode, and those with hemophilia were excluded. Demographic data, clinical information, angiographic findings, treatment, and outcomes were tabulated.
  
  
  RESULTS
  The search identified 119 titles of which 24 were deemed relevant, comprising 91 patients undergoing 99 embolization procedures. Mean time from prosthesis implantation was 32.2 months. Technical success was 99%. Mean follow-up time was 24.9 months. There were 10 recurrences (10%). Two cases were complicated by joint infection requiring arthroplasty revision.
  
  
  CONCLUSIONS
  Transarterial embolization for recurrent spontaneous hemarthrosis may be safe and effective in patients having undergone arthroplasty of the affected joint.
authors.affiliation: Division of Vascular and Interventional Radiology, Department of Radiology, Mount Sinai Beth Israel, First Avenue at 16th Street, New York, NY, 10003, USA.
authors.forename: Marcin K
authors.initials: MK
authors.lastname: Kolber
authors.affiliation: Division of Vascular and Interventional Radiology, Department of Radiology, Mount Sinai Beth Israel, First Avenue at 16th Street, New York, NY, 10003, USA.
authors.forename: Pratik A
authors.initials: PA
authors.lastname: Shukla
authors.affiliation: Division of Vascular and Interventional Radiology, Department of Radiology, Mount Sinai Beth Israel, First Avenue at 16th Street, New York, NY, 10003, USA.
authors.forename: Abhishek
authors.initials: A
authors.lastname: Kumar
authors.affiliation: Division of Vascular and Interventional Radiology, Department of Radiology, Mount Sinai Beth Israel, First Avenue at 16th Street, New York, NY, 10003, USA.
authors.forename: Adam
authors.initials: A
authors.lastname: Zybulewski
authors.affiliation: Division of Vascular and Interventional Radiology, Department of Radiology, Mount Sinai Beth Israel, First Avenue at 16th Street, New York, NY, 10003, USA.
authors.forename: Todd
authors.initials: T
authors.lastname: Markowitz
authors.affiliation: Division of Vascular and Interventional Radiology, Department of Radiology, Mount Sinai Beth Israel, First Avenue at 16th Street, New York, NY, 10003, USA. jsilberzweig@chpnet.org.
authors.forename: James E
authors.initials: JE
authors.lastname: Silberzweig
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D004621:Embolization, Therapeutic / Q000379:methods*; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D006395:Hemarthrosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence
keywords: Arthroplasty; Embolization; Hemarthrosis