Knee
Revision
Total knee replacement
Clinical Challenge: How would you address this complex revision TKA case?
This clinical challenge involves extensive periprosthetic tibial osteolysis following total knee arthroplasty. How would you approach reconstruction in this patient?
CH Perpignan, France
Clinical presentation
- 74-year-old woman, independent and in good general health
- Past medical hx: Atrial fibrillation (Eliquis) and hypertension (bisoprolol)
- Bilateral primary TKR performed more than 15 years ago
- Presented with several months of persistent medial-sided left knee pain
- Patient requesting surgical intervention due to her persistent debilitating knee pain
Physical Examination
- No knee effusion
- Medial-sided pain and tenderness over the proximal tibia
- Good ROM : full extension to 110°
- No frontal or sagittal laxity
Xray
Infection work-up
- CRP/ESR neg
- Bone scintigraphy: Non-avid osteolytic lesion beneath the medial tibial baseplate (granuloma?)
- Radiolabeled leukocyte scintigraphy: No evidence of active infection
Scanner
Extensive medial metaphyseal epiphyseal periprosthetic osteolysis with thinning of the cortex.
MRI
Well-defined, oval-shaped lesion (74 × 34 mm) with subtle peripheral enhancement following contrast administration, suggestive of a granulomatous lesion.
No features of GCT.
Management
Diagnostic: Extensive periprosthetic osteolysis with possible granuloma/ aseptic loosening.