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Dr.Sawhney
Dr.Sawhney, Doctor
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Experience:  MBBS,MS
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HELP!! Synovial sac bleeding into the knee joint. Thirteen

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HELP!! Synovial sac bleeding into the knee joint. Thirteen years ago I had two total knee replacements. Three years ago my right knee began feeling tight and swollen and in a few days the swelling was gone. This continued for seven months. April 2008 I had hemorrhaging into my righ tknee so severe that I thought the knee would explode. The next morning my knee surgeon withdrew blood from the knee. After x-rays and an Angiograph with no bleeder found I had a total right knee rivision done to see what was causing the bleeding. Dr. found that the lining of the synovial sac was all shredded and bleeding. He did a complete synovectomy. He told me a new synovial sac lining would grow and I should have no more problems. Five months later the swelling began again. My Dr. did not know what was causing the problem. The past two months I have had two severe hemmorhages again. After talking with several other Doctors none of them have ever heard of this problem. I am DESPERATE for some help and hope that someone out there has had this same knee problem. Is there a Doctor that has encountered this synovial sac bleeding problem? And if so how did you treat it? I would appreciate any help I can get. My email is: XXX@XXXXXX.XXX

Let me give you all of the details though long. It may help you in sorting out the problem.

My two total knee replacements in 1997 were very successful.July 2007 my right knee started locking and catching onto something inside of my leg just below my knee. This locking and catching happened only in bed during the night and I would have to work with my knee to un-lock it. A month later a new problem. My right knee would periodically feel tight and swollen and by the next day it was fine. The locking and the swelling did not seem to be related.
As the months past this happened once or twice a month. I would wear my ted hose to give the knee support and help the swelling to go down. There was no rhyme or reason to why or when either the locking or the swelling happened. I tried to connect it to exercise or diet, but could not. A friend who is a Chiropractor suggested I use some of his Herbs etc. He gave me a dry mud that needed to be mixed with distilled water. I was to put the mud on my knee scar and leave it for ten minutes then wipe it off and soak my feet in a liquid mud mixture. I began the treatment April 2, 2008. I do not know if that mud teeatment had any effect on what happened four days lataer but on the morning of April 6, 2008 I had just gotten out of the shower and I felt the swelling come in my right knee again but this time it didn't stop. It felt as if I had a garden hose FILLING my right knee until I thought it was going to burst. The pain was excruciating and the pain lasted for hours before I began to feel some relief. I could not even retain a pain pill because the nausea was so bad. The next morning I met my Ortho Dr. in the emergency room and he withdrew blood from my right knee and sent it to the lab to be cultured (Negative). He also did X-rays. April 10th I had an Angiography done to see if I had a bleeder. I did not. April 29th my Doctor did a Total Right Knee Rivision to see what was causing the bleeding. He said he found that the lininhg of the Synovial Sac was all shredded and bleeding. He scraped out the lining and sent to lab (negative) he checked my prothsesis and all was well though he chose to put in a new plastic insert. He closed my knee. He said that a new synovial sac lining would grow back and that I should not have any more problems. The surgery was as painful as my total knee surgery had been and I had to do the Physical therapy for two months and continue on my own for several more months to keep scar tissue from forming in my knee. It was a difficult experience. Four months after surgery (Sept. 2008) my knee locking and then stiffness began again. I went back to my Ortho DR. After more XRays he said he did not know what was causing the problem. He suggested I wear a knee brace to bed, which I did but it didn't make any difference. I went to my family Dr. and he did not know the answer. He sent me to another Ortho Dr. who does knee replacements and he did not know the answer. I have done a lot of research on the internet but have not found any help with this problem. Two months ago (May 1st) I attended a graduation that required my climbing many steps several times and that evening my knee filled tight again. It frightened me. I have had to stop walking everyday for exercise for fear my knee will bleed again. In June I wondered about Acupuncture. June 17th I tried it. Seventeen needles of which four were placed in each knee. An infared lamp was placed above my right knee during the treatment. Eighteen hours later (June 18th) I was awakened at 5:30 am with my knee filling as with the force of a garden hose. I quickly wrapped ace bandages around my knee and put ice on it but the filling continued and the pain was excruciating. I thought my knee was going to explode. The pain lasted six hours before it began to ease off. I have to feel that the acupuncture treatment had something to do with the knee bleeding internally again. I have tried uncuccessfully to get into two other doctors because my problem was not due to a sports injury, and perhaps they do not know what the problem is either. I surely am not the only one that has had this problem of bleeding from the synobial sac into the knee jount. There has to be a doctor out there that has had experience with a patient that has had this problem. I would deeply appreciate any help you can give me.

How important is the synovial sac to a titanium prosthesis? Could the synovial sac be completly removed so it cannot bleed and my problem would be solved. ???
Submitted: 4 years ago.
Category: Medical
Expert:  Dr Brims replied 4 years ago.
Hello,
have they checked you for a bleeding disorder?
Customer: replied 4 years ago.
Yes. My Dr. checked the blood he withdrew the day after the first hemorrhage and there was no disorder. He did a good job on everything but does not know the reason for the bleeding.
Expert:  Dr Brims replied 4 years ago.
Did they take a biopsy of the synovium when they operated?
Customer: replied 4 years ago.
Yes a biopsy of the synovium was done at the time of the surgery and it came back negative.
Expert:  Dr Brims replied 4 years ago.
I see, I will opt out and refer you to another orthopaedic surgeon on the site.Hopefully he will be able to help you
Customer: replied 4 years ago.
Thank You.
Customer: replied 4 years ago.
You asked if I had been checked for bleeding. Not since before the surgery in 2008, and the day after the bleed my doctor withdrew blood from my knee. I had to meet him in the emergency room between his surgeries. He sent the blood to the lab and all was negative. The only time it can be checked is after the bleeds and to get into a doctor the wait is three to four weeks and by then the blood in my knee has been reabsorbed. I am certain it is bleeding because the symptoms are all exacally the same as before the surgery. I do not want to go through another surgery if possible. The synovial sac is obviously diseased or irritated and I hope to find a way to heal it. You may be wondering if I am overweight. I am not. I am five foot 7 inches tall and I weigh 147 pounds. Up until these recent bleeds I walked two miles every day.
Customer: replied 4 years ago.
Thank you for your help. My question about having the synovial sac removed was not answered. That would solve my bleeding problem if it was removed. How vital is the synovial sac to a titanium knee replacement???
Expert:  Dr.Sawhney replied 4 years ago.
Synovial sac is actually the joint cavity and it contains synovial tissue.The sac cannot be removed completely and neither can whole of synovium be removed.Even if most of synovium is removed it can hypertrophy again therefore this cannot be definitive treatment.
Customer: replied 4 years ago.
Thank you for the understanding of the impossibility of removing the synovial sac. Would you define for me Blood dissorder? I understand Hemophelia, and Anemia but in trying to think this through I cannot understand how the knee could bleed off and on without a trauma to it. What type of rare blood disorder are you thinking it could possible be??? I so appreciaate your help.
Expert:  Dr.Sawhney replied 4 years ago.
Blood clots through a complex mechanism and clotting process is called a cascade with several different biochemical mediators involved in the process.
Any problem in the cascade may be responsible for bleeding tendency.If you are on any blood thinning medicines they may also be responsible.Deficiency of Vitamin K and platelets may also be responsible.

I am not a hematologist and frankly cannot tell you exactly the possible bleeding disorders which may have caused this but if I was your surgeon I would have sought the opinion of a hematologist to get a better grip on the condition.

I did have a patient who presented several years after the surgery with a swollen knee.His knee prosthesis seemed to be fine.Underwent aspiration and blood collected again after a few days.Did discuss with my colleagues one of whom suggested going in and having a look.(I think the story seems familiar to you).But I referred him to a hematologist who diagnosed a bleeding disorder and when it was treated patient got better.
Customer: replied 4 years ago.
I am not on blood thinners and at my physical exam earlier this year my hmct. was a bit low at 37and I have been taking iron pills. Your answer gives me much HOPE. How did they treat your patient that had the blood disorder?
Expert:  Dr.Sawhney replied 4 years ago.
A low hematocrit would have no bearing on the clotting ability of the blood.

I am unable to tell you about the treatment that patient received as patient passed into the care of hematologist and has not followed up with me since that time.

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