Park Justin J, Slover James D, Stuchin Steven A
Division of Orthopedic Surgery, New York University Hospital for Joint Diseases, New York, New York 10003, USA. justin.park@ nyumc.org
Orthopedics. 2010 Oct 11;33(10):771. doi: 10.3928/01477447-20100826-25.
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.
全膝关节置换翻修术后复发性关节积血是一种罕见的并发症。丙型血友病患者在接受大手术后出现出血并发症的可能性难以预测。尽管使用术后化疗药物预防深静脉血栓形成（DVT）被认为是大多数患者的标准治疗方法，但其在血友病患者中的应用尚不清楚。本病例描述了一名丙型血友病女性患者，在全膝关节置换翻修术后9天出现复发性关节积血。最初的治疗措施旨在治疗患者潜在的凝血病。反复输注新鲜冰冻血浆和去氨加压素以试图实现止血。然而，关节积血并未消退，术后36天，通过血管造影发现左膝上动脉假性动脉瘤并进行了经皮栓塞。据我们所知，本文介绍了首例血友病患者全膝关节置换翻修术后复发性关节积血的病例。它进一步强调了在面对复杂的临床情况时，考虑术后出血的所有可能原因以做出及时诊断的重要性。
