無症候性膝窩動脈閉塞が関連したと思われる人工膝関節置換術後の難治性反復性関節血症：1例報告

Recurrent Hemarthrosis after Total Knee Arthroplasty Possibly Related to Asymptomatic Popliteal Artery Obstruction. Case Report

　無症候性膝窩動脈閉塞が関連したと思われる人工膝関節置換術後の反復性関節血症を経験した．症例は，69歳の女性である．出血傾向や膝窩動脈の閉塞を示唆する症状はなく，末梢動脈の拍動も正常であった．変形性膝関節症の診断で人工膝関節置換術を施行した．術後1週より関節血症を繰り返した．滑膜切除を複数回施行したが，その後も再発を繰り返した．動脈造影を行ったところ，膝窩動脈の閉塞と発達した側副血行路が認められた．膝窩動脈の開通後6カ月の時点で，関節血症の再発は認められない．

　We report a case of recurrent hemarthrosis after total knee arthroplasty (TKA) that may have been related to asymptomatic popliteal artery obstruction. A 69-year-old woman underwent TKA for osteoarthritis. Her past medical history was unremarkable. Peripheral pulses were normal, and there was no evidence of a bleeding tendency or arterial obstruction in the preoperative examination. Hemarthrosis developed one week after TKA and subsequently recurred 17 times despite several synovectomies. Diagnostic angiography showed popliteal artery obstruction and a highly developed collateral pathway. There have been no recurrences of the hemarthrosis as of six months after reopening the popliteal artery by catheter pass.