Does knee embolization (embolization of the knee) affect future knee replacement surgery?

Impact of Knee Embolization on Future Knee Replacement Surgery

Knee embolization procedures do not negatively impact future knee replacement surgery and may be safely performed prior to eventual arthroplasty without compromising surgical outcomes.

Understanding Knee Embolization

Knee embolization, specifically genicular artery embolization (GAE), is a minimally invasive procedure that has two main clinical applications:

• Treatment of recurrent hemarthrosis (bleeding into the joint) after knee surgery, particularly following total knee arthroplasty (TKA) 1, 2
• Management of knee osteoarthritis pain in patients who are not yet candidates for knee replacement 3, 4

Effect on Future Knee Replacement

The available evidence does not indicate any negative impact of prior knee embolization on subsequent knee replacement surgery:

• No guidelines or research suggest that embolization procedures compromise future knee arthroplasty outcomes 5
• The American College of Radiology's Appropriateness Criteria for imaging after total knee arthroplasty acknowledges embolization as a treatment option for recurrent hemarthrosis without noting concerns about its impact on revision surgeries 5
• Embolization targets specific abnormal hyperemic vessels while preserving normal vasculature, which minimizes potential impact on future surgical procedures 3

Technical Considerations

When knee embolization is performed, several technical aspects help ensure it won't negatively affect future knee replacement:

• Selective catheterization targets only the abnormal hyperemic genicular arteries, preserving normal vascular supply 4
• Embolic materials are carefully selected based on vessel characteristics, with particles sized 75-700 μm being commonly used 1, 4
• The goal is to reduce abnormal hypervascularity rather than completely occlude all blood supply to the area 3

Timing Considerations

For patients who may eventually need knee replacement after embolization:

• No specific waiting period between embolization and subsequent knee replacement is mandated in guidelines 5
• The vascular changes from embolization stabilize within weeks, allowing for safe subsequent surgery 6
• Surgical planning for knee replacement should include review of prior embolization records to understand the vascular anatomy 5

Potential Benefits for Subsequent Surgery

Embolization may actually provide benefits for subsequent knee replacement:

• Reduction in synovial hypervascularity may decrease intraoperative bleeding during future knee arthroplasty 3
• Improved pain control from embolization may allow for better preoperative physical conditioning, potentially improving arthroplasty outcomes 5
• Management of hemarthrosis through embolization can prevent joint damage that might complicate future knee replacement 2

Potential Risks and Complications

While generally safe, knee embolization carries some risks that surgeons should be aware of when planning future knee replacement:

• Skin discoloration occurred in 42% of patients in one study, though this was self-limited 4
• Rare but serious complications include skin/mucosal tissue necrosis and infection 6, 2
• One study reported a case of aseptic necrosis of the femoral condyles in an elderly patient on anticoagulants, which could potentially complicate future knee replacement 2

Special Considerations

Certain patient factors require additional attention when considering embolization before potential knee replacement:

• Patients with blood dyscrasias or on therapeutic anticoagulation may have higher rates of recurrent hemarthrosis even after embolization, potentially affecting surgical planning 1
• Patients with significant comorbidities may have less successful outcomes from embolization and may require additional planning for eventual knee replacement 1

Conclusion

Based on current evidence, knee embolization procedures can be safely performed without negatively impacting future knee replacement surgery. The selective nature of the embolization technique preserves normal vasculature while addressing specific pathologic vessels, allowing for subsequent successful knee arthroplasty when indicated.