Periarticular aneurysm formation in haemophilia.

BACKGROUND: Spontaneous bleeding into the joints is common in haemophilia. Recurrent intra-articular bleeding leads to joint destruction. In the past 4 years we have carried out sixteen total knee replacements for haemophilic arthropathy. In three patients there was persistent bleeding with haemarthrosis, manifest skin discolouration, severe pain, and swelling, which was caused by a periarticular aneurysm.
METHODS: Using angiography as part of the preoperative preparation, we initiated a prospective study. Ten angiographic examinations (six preoperative, two postoperative, one both) were carried out in seven patients without major complications.
FINDINGS: In seven of the ten angiographic examinations, three preoperative and four postoperative, we found aneurysms around the knee. Since the patients with a positive postoperative finding did not have preoperative studies, we do not know whether the aneurysms existed before surgery.
INTERPRETATION: Aneurysms can cause increased bleeding and other complications. The occurrence of spontaneous periarticular aneurysms in haemophilia has not been explored. In these cases, the resultant bleeding led to serious clinical symptoms that were not responsive to conservative measures. This new finding is relevant to those who surgically treat haemophilia patients. Angiography--and, when indicated, embolisation--before total knee replacement proved simple and effective as a diagnostic and therapeutic procedure.