Transarterial Embolization for Refractory Ankle Synovitis in an Adult Patient With a History of Juvenile Idiopathic Arthritis

Juvenile idiopathic arthritis is a rare but severe childhood-onset arthritis that carries a high risk of structural joint damage. We report the case of a 32-year-old man with a history of juvenile idiopathic arthritis who underwent bilateral hip arthroplasty at age 23 and bilateral ankle arthroplasty at age 24. His subsequent orthopedic course was complex, involving a left ankle prosthetic infection, spacer implantation, and eventual reimplantation of the prosthesis. Despite these interventions, he developed persistent left ankle pain, swelling, and warmth, consistent with residual synovitis. The patient was treated with adalimumab and had no evidence of active arthritis at other sites. Non-steroidal anti-inflammatory drugs, sural nerve neuromodulation, and intra-articular glucocorticoid injections failed to provide adequate relief. Selective transarterial embolization of the malleolar branch of the anterior tibial artery was therefore performed, resulting in marked improvement in pain and swelling. In conclusion, transarterial embolization proved feasible and led to meaningful short-term clinical benefit, supporting its potential as an adjunctive therapeutic option in carefully selected cases of residual refractory ankle arthritis.