Genicular Artery Embolization Reduces Synovial Hyperemia in Patients With Hemophilia Undergoing Total Knee Replacement

According to a study published in Haemophilia, genicular artery embolization (GAE), a minimally invasive procedure that reduces blood flow to the synovium, prior total knee replacement (TKR) showed promising results in reducing moderate to severe synovial hyperemia in patients with hemophilia.

TKR has proven to be an effective solution for relieving pain and improving joint function in hemophilic patients with severe joint damage. However, the perioperative and postoperative bleeding risks associated with clotting factor therapy during TKR remain a challenge. To address this issue, researchers conducted a retrospective cohort study that aimed to “evaluate the prevalence of preoperative synovial hyperemia and the effects of [GAE] on synovial hyperemia and 3-month postoperative joint bleeding.”

The study involved a cohort of patients with hemophilia who underwent periarticular catheter angiography between 2009 and 2020. An interventional radiologist assessed the presence and severity of synovial hyperemia based on angiography images. A total of 33 angiography procedures were conducted in 24 patients. The median age of the participants was 54.4 years (range, 48.4-65.9 years).

Preoperative synovial hyperemia was observed in 64% of the evaluated joints. Moderate to severe synovial hyperemia was observed in 30%. The findings indicated that a substantial proportion of patients with hemophilia requiring TKR displayed notable preoperative synovial hyperemia.

The study also examined the impact of GAE on synovial hyperemia. In 87% of cases, synovial hyperemia decreased after GAE. This finding suggests that GAE can effectively reduce synovial hyperemia in preparation for TKR, potentially minimizing bleeding risks during and after the surgical procedure.

Furthermore, the researchers investigated the occurrence of 3-month postoperative joint bleeding in the study cohort. The results showed that 11% of the joints without preoperative synovial hyperemia experienced bleeding, and 21% of the joints with mild synovial hypertrophy also experienced bleeding. The presence of residual mild synovial hyperemia did not seem to significantly influence the incidence of postoperative joint bleeding.

“Preoperative [GAE] reduced synovial hyperemia and is expected to limit postoperative bleeds in the vulnerable joint during rehabilitation. We observed a significant reduction of synovial hyperemia after embolization,” the researchers concluded. “However, no significant difference was observed in 3-month postoperative joint bleeding between joints with and without residual synovial hypertrophy. This may be explained by the low number of joints with predominantly mild residual synovial hyperemia after genicular artery embolization.”