From the Guidelines
Management of hemarthrosis in the knee joint should initially focus on the RICE protocol, pain control with analgesics, and joint aspiration to remove blood and prevent further synovial damage. The presence of Red Blood Cells (RBCs) in the synovial fluid indicates hemarthrosis, which requires prompt treatment to prevent long-term joint damage 1. Key steps in management include:
- Rest, ice, compression, and elevation (RICE) to reduce pain and inflammation
- Pain control using analgesics such as acetaminophen or NSAIDs like ibuprofen or naproxen
- Joint aspiration to remove blood from the joint space, relieving pain and preventing synovial damage
- Identification and addressing of the underlying cause, whether trauma, bleeding disorders, or anticoagulant use In cases of recurrent hemarthrosis, orthopedic consultation is necessary to evaluate for structural damage or synovitis, and diagnostic procedures like angiography may be considered to diagnose conditions such as synovial hyperemia or arteriovenous malformations 1.
From the Research
Management of Hemarthrosis
The presence of Red Blood Cells (RBCs) in the synovial fluid of the knee joint indicates hemarthrosis, which can be caused by traumatic or non-traumatic injuries. The management of hemarthrosis is crucial to prevent long-term damage to the joint.
Traumatic Hemarthrosis
- Joint aspiration is recommended to minimize the harmful effects of blood on the cartilage and synovium 2.
- The presence of blood in the joint can lead to the release of pro-inflammatory mediators, which can cause degenerative changes in the joint 2.
- Joint aspiration has been shown to reduce the time to full resolution of hemarthrosis, duration of treatment, and time to recovery of pre-bleed range of motion 3.
Non-Traumatic Hemarthrosis
- In patients with hemophilia, joint aspiration is a well-tolerated technique that can accelerate recovery from acute hemarthrosis 3.
- The frequency of bleeding risk in patients receiving warfarin and undergoing arthrocentesis is not very high, and oral anticoagulant therapy is not an absolute contraindication to arthrocentesis 4.
Biochemical Response to Trauma
- An acute knee injury is associated with an instant local biochemical response, which may affect cartilage and bone as well as inflammatory activity 5.
- The concentrations of cartilage and bone markers, and pro-inflammatory cytokines are increased in synovial fluid in the acute phase of knee injury (hemarthrosis) 5.