Selective Genicular Artery Embolisation for Recurrent Hemarthrosis Following Total Knee Arthroplasty: A Case Report

Abstract

Recurrent hemarthrosis following total knee arthroplasty (TKA) is an uncommon complication, with an incidence of less than 1%. It can lead to pain, swelling, joint stiffness, and functional impairment. Selective genicular artery embolisation (GAE) has emerged as a minimally invasive treatment for managing such cases. We report the case of a 79-year-old female with recurrent atraumatic hemarthrosis of the left knee following TKA, complicated by long-term anticoagulation with Edoxaban for unprovoked pulmonary embolism. Despite multiple aspirations and arthroscopic washouts, symptoms persisted. Angiography revealed synovial hypervascularity, and GAE was performed to reduce bleeding. Although the procedure initially improved symptoms, recurrence occurred while the patient was maintained on full-dose Edoxaban. Following a multidisciplinary review, the anticoagulant dose was reduced, resulting in complete resolution of haemarthrosis. GAE represents an effective, minimally invasive treatment for recurrent hemarthrosis post-TKA. Anticoagulation management and multidisciplinary coordination are essential to balance bleeding risk and thromboembolic protection in such patients.