Delayed Hemarthrosis Due to Superior Lateral Genicular Artery Bleeding Following Total Knee Arthroplasty in a Patient With Rheumatoid Arthritis: A Case Report

Abstract Introduction:Spontaneous non-hemophiliac hemarthrosis is a rare but potentially serious complication following total knee arthroplasty (TKA), with a reported prevalence of 0.3–0.65%. Although its etiology is often multifactorial, patients with rheumatoid arthritis (RA) may be particularly predisposed due to synovial hypervascularization. Timely diagnosis and structured management are critical to avoid prosthetic joint compromise. Case Presentation:We present the case of a 57-year-old woman with a history of RA who developed recurrent spontaneous hemarthrosis two years after primary TKA. CT angiography revealed active extravasation from the superior lateral genicular artery and an organized intracapsular hematoma. The patient underwent successful selective arterial embolization, resulting in complete symptom resolution without recurrence during follow-up. Discussion:This case underscores the importance of including vascular causes in the differential diagnosis of unexplained hemarthrosis after TKA. Arteriography serves as a valuable diagnostic and therapeutic tool, allowing for identification and embolization of bleeding sources. Compared to surgical interventions, embolization is less invasive and facilitates faster recovery.Conclusion:Vascular complications such as genicular artery bleeding, though rare, should be considered in cases of recurrent hemarthrosis post-TKA. A stepwise approach involving joint aspiration, imaging, and embolization can lead to successful outcomes while minimizing surgical morbidity.