From the Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada (Dr. Ravi and Dr. Backstein), the Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (Dr. Ravi and Dr. Hosack), the Klamath Orthopaedic Clinic, Klamath Falls, OR (Dr. Hosack), the Division of Orthopaedic Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada (Dr. Backstein), and the Department of Orthopaedic Surgery, Mayo Clinic, Phoenix, AZ (Dr. Spangehl).
J Am Acad Orthop Surg. 2019 Sep 1;27(17):652-658. doi: 10.5435/JAAOS-D-18-00182.
Recurrent hemarthrosis (RH) is a rare complication (∼1%) after total knee arthroplasty (TKA). It is a complex and particularly frustrating problem for both patient and surgeon. Typically, patients present several months to years after their index TKA surgery with a painful and swollen joint. Although conservative management may provide temporary relief, the rate of recurrence is high. Despite extensive case series in the literature, no consensus was made on the criteria needed to establish this diagnosis, or how to best provide treatment. Several management strategies have been described for RH, including immobilization, arthroscopic versus open synovectomy, angiographic embolization, and revision arthroplasty. All of these have demonstrated variable effectiveness, with limited evidence for their use in specific situations. This review synthesizes the available literature and suggests an algorithm for the diagnosis and treatment of RH after TKA.
复发性膝关节血肿（RH）是全膝关节置换术后（TKA）罕见的并发症（约 1%）。它是患者和外科医生都面临的一个复杂且特别令人沮丧的问题。通常，患者在接受 TKA 手术后数月至数年出现关节疼痛和肿胀。尽管保守治疗可能暂时缓解，但复发率很高。尽管文献中有大量的病例系列，但尚未就确立这一诊断所需的标准达成共识，也没有就如何提供最佳治疗方法达成共识。已经描述了几种针对 RH 的管理策略，包括固定、关节镜与开放式滑膜切除术、血管造影栓塞术和翻修关节置换术。所有这些方法都显示出不同的有效性，在特定情况下使用它们的证据有限。本综述综合了现有文献，并提出了 TKA 后 RH 的诊断和治疗算法。
