Successful Treatment of Recurrent Hemarthrosis after Total Knee Arthroplasty Using Genicular Artery Embolization in a Patient with Rheumatoid Arthritis.

Recurrent hemarthrosis after total knee arthroplasty (TKA) is a rare but challenging complication, with an incidence ranging from 0.3% to 1.6%. Conservative treatment, including rest, joint aspiration, and oral tranexamic acid, is often the first-line approach, but approximately two-thirds of cases require more invasive procedures. Genicular artery embolization (GAE) has emerged as a promising alternative to synovectomy for refractory cases, offering high success rates with fewer complications. While most reports of GAE for recurrent hemarthrosis focus on patients with osteoarthritis, data on its use in patients with rheumatoid arthritis (RA) are scarce. We report a case of a 79-year-old woman with RA who presented with recurrent hemarthrosis 11 years after TKA. Despite conservative treatment, her hemarthrosis persisted. Angiography revealed three hypervascular areas supplied by branches of the superior lateral, superior medial, and middle genicular arteries. Embolization was successfully performed using gelatin sponge, resulting in complete symptom resolution without recurrence at the two-year follow-up. This case highlights the potential of GAE as a viable treatment option for recurrent hemarthrosis in patients with RA, particularly those with multiple bleeding sites or when synovectomy is unsuccessful or impractical. Careful evaluation from multiple angiographic angles is crucial to detect all bleeding sources, especially in post-TKA cases where metal implants may obscure vascular regions. Although further studies are needed, GAE may represent a safe and effective alternative for managing recurrent hemarthrosis in patients with RA.