Surgical exploration resolved recurrent hemarthrosis in a patient with total knee arthroplasty.

BackgroundRecurrent hemarthrosis following total knee arthroplasty (TKA) is an uncommon but challenging complication. While angiographic intervention is typically effective, some cases require surgical intervention.Case presentationWe report a 69-year-old woman who developed recurrent, non-traumatic hemarthrosis of the left knee 11 months after bilateral total knee arthroplasty. Diagnostic digital subtraction angiography (DSA) demonstrated an abnormal angiographic blush in the suspected branch of the lateral inferior genicular artery, raising suspicion of a possible pseudoaneurysm but without definitive diagnostic features. No active contrast extravasation was observed during angiography, and therefore transcatheter arterial embolization was not performed at that time. Surgical exploration revealed synovial hyperplasia, flexion instability, and pulsatile bleeding from a small artery at the posterolateral superior aspect of the knee joint. Ligation, synovectomy, and spacer exchange were performed.OutcomeThe patient experienced complete symptom resolution and restored joint function during a two-year follow-up.ConclusionThis case underscores that recurrent hemarthrosis after total knee arthroplasty may be multifactorial. In the setting of negative angiography or inability to perform embolization, surgical exploration plays a critical role in identifying occult bleeding sources, mechanical instability, and soft-tissue pathology.