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Wear debris pseudotumor following total knee arthroplasty: a case report.

Mavrogenis AF, Nomikos GN, Sakellariou VI, Karaliotas GI, Kontovazenitis P, Papagelopoulos PJ - J Med Case Rep (2009)

Bottom Line: Intraoperative findings revealed massive metallosis related to extensive polyethylene wear, delamination and deformation.Revision knee and patella arthroplasty was carried out after a thorough debridement of the knee joint.In these cases, revision arthroplasty may provide a satisfactory knee function.

View Article: PubMed Central - HTML - PubMed

Affiliation: First Department of Orthopaedics, ATTIKON University General Hospital, Athens University Medical School, Athens, Greece.

ABSTRACT

Introduction: In patients who have undergone a total joint replacement, any mass occurring in or adjacent to the joint needs thorough investigation and a wear debris-induced cyst should be suspected.

Case presentation: An 81-year-old man presented with a painful and enlarging mass at the popliteal fossa and calf of his right knee. He had had a total right knee replacement seven years previously. Plain radiographs showed narrowing of the medial compartment. Magnetic resonance imaging showed a cystic lesion at the postero-medial aspect of the knee joint mimicking popliteal cyst or soft tissue sarcoma. Fine needle aspiration was non-diagnostic. A core-needle biopsy showed metallosis. Intraoperative findings revealed massive metallosis related to extensive polyethylene wear, delamination and deformation. Revision knee and patella arthroplasty was carried out after a thorough debridement of the knee joint.

Conclusion: Long-term follow-up is critical for patients with total joint replacement for early detection of occult polyethylene wear and prosthesis loosening. In these cases, revision arthroplasty may provide a satisfactory knee function.

No MeSH data available.


Related in: MedlinePlus

Intraoperative photographs show (A) massive metallosis of the soft tissue adjacent to the prostheses, and (B) extensive wear, delamination and deformation of the polyethylene insert distributed asymmetrically over the medial and lateral joint surfaces.
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Figure 4: Intraoperative photographs show (A) massive metallosis of the soft tissue adjacent to the prostheses, and (B) extensive wear, delamination and deformation of the polyethylene insert distributed asymmetrically over the medial and lateral joint surfaces.

Mentions: Revision knee surgery showed massive metallosis, osteolysis of the distal femur and the proximal tibia and extensive polyethylene wear and deformation distributed asymmetrically over the medial and lateral joint surfaces (Figure 4). Debridement of the knee joint was done followed by revision of the femoral and tibial components and the polyethylene insert, in addition to patella arthroplasty (Figure 5). The patient's recovery was uncomplicated. His rehabilitation included strengthening and a range of motion exercises, which he started on the second postoperative day. The patient was discharged uneventfully after seven days of hospitalization. At the latest examination 2.5 years post-operatively the patient had a painless and stable knee joint without any clinical or imaging evidence of wear, metallosis or infection.


Wear debris pseudotumor following total knee arthroplasty: a case report.

Mavrogenis AF, Nomikos GN, Sakellariou VI, Karaliotas GI, Kontovazenitis P, Papagelopoulos PJ - J Med Case Rep (2009)

Intraoperative photographs show (A) massive metallosis of the soft tissue adjacent to the prostheses, and (B) extensive wear, delamination and deformation of the polyethylene insert distributed asymmetrically over the medial and lateral joint surfaces.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2803827&req=5

Figure 4: Intraoperative photographs show (A) massive metallosis of the soft tissue adjacent to the prostheses, and (B) extensive wear, delamination and deformation of the polyethylene insert distributed asymmetrically over the medial and lateral joint surfaces.
Mentions: Revision knee surgery showed massive metallosis, osteolysis of the distal femur and the proximal tibia and extensive polyethylene wear and deformation distributed asymmetrically over the medial and lateral joint surfaces (Figure 4). Debridement of the knee joint was done followed by revision of the femoral and tibial components and the polyethylene insert, in addition to patella arthroplasty (Figure 5). The patient's recovery was uncomplicated. His rehabilitation included strengthening and a range of motion exercises, which he started on the second postoperative day. The patient was discharged uneventfully after seven days of hospitalization. At the latest examination 2.5 years post-operatively the patient had a painless and stable knee joint without any clinical or imaging evidence of wear, metallosis or infection.

Bottom Line: Intraoperative findings revealed massive metallosis related to extensive polyethylene wear, delamination and deformation.Revision knee and patella arthroplasty was carried out after a thorough debridement of the knee joint.In these cases, revision arthroplasty may provide a satisfactory knee function.

View Article: PubMed Central - HTML - PubMed

Affiliation: First Department of Orthopaedics, ATTIKON University General Hospital, Athens University Medical School, Athens, Greece.

ABSTRACT

Introduction: In patients who have undergone a total joint replacement, any mass occurring in or adjacent to the joint needs thorough investigation and a wear debris-induced cyst should be suspected.

Case presentation: An 81-year-old man presented with a painful and enlarging mass at the popliteal fossa and calf of his right knee. He had had a total right knee replacement seven years previously. Plain radiographs showed narrowing of the medial compartment. Magnetic resonance imaging showed a cystic lesion at the postero-medial aspect of the knee joint mimicking popliteal cyst or soft tissue sarcoma. Fine needle aspiration was non-diagnostic. A core-needle biopsy showed metallosis. Intraoperative findings revealed massive metallosis related to extensive polyethylene wear, delamination and deformation. Revision knee and patella arthroplasty was carried out after a thorough debridement of the knee joint.

Conclusion: Long-term follow-up is critical for patients with total joint replacement for early detection of occult polyethylene wear and prosthesis loosening. In these cases, revision arthroplasty may provide a satisfactory knee function.

No MeSH data available.


Related in: MedlinePlus