Asanuma Kunihiro, Ito Haruo, Ogawa Akito, Asanuma Yumiko, Yoshikawa Tomoaki, Hasegawa Masahiro, Sudo Akihiro
Mie University School of Medicine, 2-174 Edobashi, Tsu City, Mie, Japan.
Orthopedics. 2011 Sep 9;34(9):e578-80. doi: 10.3928/01477447-20110714-20.
Recurrent hemarthrosis after knee arthroplasty can be disabling, requiring adequate and immediate diagnosis and treatment for recovery of symptoms and joint function. The most commonly reported cause is impingement of proliferative synovium between prosthetic components. Although various procedures for hemarthrosis have been reported after knee arthroplasty for patients who do not respond to conservative treatment, the recommended first-line therapy is open surgery or embolization. Although hyperplastic synovium was observed during the first and second arthrotomy, in our case, tissue impingement was not detected. We describe a rare case of recurrent hemarthrosis after unicompartmental knee arthroplasty (UKA) and successful treatment by open synovectomy. A 66-year-old woman presented with spontaneous osteonecrosis of the medial femoral condyle in the right leg. She underwent UKA of the right knee of the medial condyle. Eighteen months after UKA, the patient developed recurrent hemarthrosis. Open arthrotomy was performed 22 months after UKA, revealing only hematoma with no obvious hemorrhage or loosening of the prosthesis. No history of trauma or use of anticoagulant medications was present. After a symptom-free period of 8 months, another 2 episodes of hemarthrosis occurred over the course of 8 months. A second open arthrotomy was performed. Hyperplastic synovium with fibrin and hemosiderin pigmentation was observed, again without hemorrhage or loosening. There were no pathological features of pigmented villonodular synovitis. Synovectomy was performed, and no hemarthrosis has recurred for 2 years.
膝关节置换术后复发性关节积血可能会导致功能障碍，需要进行充分且及时的诊断和治疗，以恢复症状和关节功能。最常报道的病因是假体部件之间增生性滑膜的撞击。尽管对于保守治疗无效的膝关节置换术后患者，已有多种治疗关节积血的方法被报道，但推荐的一线治疗方法是开放手术或栓塞。在我们的病例中，虽然在第一次和第二次关节切开术中观察到了增生性滑膜，但未检测到组织撞击。我们描述了一例单髁膝关节置换术（UKA）后复发性关节积血的罕见病例，并通过开放性滑膜切除术成功治愈。一名66岁女性出现右下肢股骨内侧髁自发性骨坏死。她接受了右膝内侧髁的UKA手术。UKA术后18个月，患者出现复发性关节积血。UKA术后22个月进行了开放性关节切开术，仅发现血肿，假体无明显出血或松动。患者无创伤史或抗凝药物使用史。在无症状8个月后，8个月内又发生了2次关节积血。进行了第二次开放性关节切开术。观察到增生性滑膜伴有纤维蛋白和含铁血黄素色素沉着，同样没有出血或松动。没有色素沉着绒毛结节性滑膜炎的病理特征。进行了滑膜切除术，2年来未再出现关节积血。
