Selective Embolization Is Safe and Effective for Total Knee Arthroplasty-Associated Recurrent Hemarthroses: A Systematic Review and Meta-Analysis.
| Autor: | Sundaram K; Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio., Arnold NR; Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio., Mont MA; Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio., Sodhi N; Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, New York., Warren J; Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, New York., Kamath AF; Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio., Piuzzi NS; Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio. |
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| Jazyk: | angličtina |
| Zdroj: | The journal of knee surgery [J Knee Surg] 2021 Jul; Vol. 34 (8), pp. 877-885. Date of Electronic Publication: 2019 Dec 31. |
| DOI: | 10.1055/s-0039-3402482 |
| Abstrakt: | Total knee arthroplasty (TKA)-associated hemarthroses are infrequent and often respond to nonoperative therapy. Geniculate artery embolization may provide symptomatic relief in cases recalcitrant to needle aspiration, although no meta-analysis exists regarding this therapy. This meta-analysis aims to assess the rate of symptom relief, the number of embolizations needed to achieve relief, and the rate of complications associated with embolization. Public databases were queried from 1998 until 2018 for TKA-associated recurrent hemarthroses treated with embolization. Eight studies met inclusion and exclusion criteria. Major complications were defined as those requiring readmission or nonelective reoperation; minor complications were defined as those not requiring readmission or reoperation. Pooled statistics were calculated utilizing the method of inverse variance. Fifty-nine patients with a mean follow-up of 30 months (range, 1-50 months) were evaluated. The pooled proportion of patients with symptom improvement following embolization was 86% (95% confidence interval [CI]: 74-93%, I 2 : 0%, p = 0.97). The average number of embolization procedures was 1.30 (95% CI: 1.03-1.63, I 2 : 0%, p = 0.66). The pooled proportion of patients who required a second embolization procedure was 26% (95% CI: 15-40%, I 2 : 0%, p = 0.43), while those requiring three or more procedures was 13% (95% CI: 6-25%, I 2 : 0%, p = 0.87). The rate of complications were as follows: any complication - 19% (95% CI: 11-32%, I 2 : 0%, p = 0.81); major complications-8% (95% CI: 3-19%, I 2 : 0%, p = 0.96); minor complications-18% (95% CI: 10-31%, I 2 : 0%, p = 0.79); inguinal hematoma-9% (95% CI: 4-19%, I 2 : 0%, p = 1.00); skin necrosis-15% (95% CI: 7-29%, I 2 : 0%, p = 0.62); and incision breakdown-7% (95% CI: 3-17%, I 2 : 0%, p = 1.00). Previous literature on selective artery embolization following TKA is relatively limited. This meta-analysis supports embolization as a potentially safe and effective treatment for recurrent hemarthroses after TKA. Other correctable causes of recurrent hemarthrosis, such as instability or malalignment, must be diligently ruled out prior to utilizing embolization. Surgeons should be aware of embolization's potential role in the postoperative period following TKA. Competing Interests: M.A.M. reports personal fees from Cymedica, grants and personal fees from DJ Orthopaedics, grants from Flexion Therapeutics, grants and personal fees from Johnson & Johnson, other from Medicus Works LLC, grants from National Institutes of Health (NIAMS & NICHD), grants and personal fees from Ongoing Care Solutions, grants and personal fees from Orthosensor, personal fees from Pacira, personal fees and other from Peerwell, personal fees from Performance Dynamics, personal fees from Pfizer, grants and personal fees from Stryker, grants from Tissue Gene, other from Up-to Date, other from USMI, other from Wolters Kluwer Health - Lippincott Williams & Wilkins, outside the submitted work. In addition, he has a patent Microport licensed, and a patent Stryker licensed and AAOS: Board or committee member, American Association of Hip and Knee Surgeons: Board or committee member, Journal of Arthroplasty: Editorial or governing board, Journal of Knee Surgery: Editorial or governing board, Knee Society: Board or committee member, Orthopedics: Editorial or governing board, Surgical Techniques International: Editorial or governing board. N.R.A. reports other from Alkermes, from Celgene, from Gilead, from Johnson & Johnson, from stryker, outside the submitted work. A.F.K. reports personal fees from Corin USA, grants and personal fees from DePuy, personal fees from Heraeus medical, other from Johnson and Johnson, grants from Orthofix Inc, personal fees from Pacira pharmaceuticals, other from Procter and Gamble, grants, personal fees, and other from Zimmer, outside the submitted work. In addition, he has a patent Innomed with royalties paid and AAOS: Board or committee member American Association of Hip and Knee Surgeons: Board or committee member BMC Musculoskeletal Disorders: Editorial or governing board. (Thieme. All rights reserved.) |
| Databáze: | MEDLINE |
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