Bilateral massive osteolysis of uncertain origin after total knee arthroplasty: A case report and review of literature
| Autor: | Rachid Rassir, Peter A. Nolte, Jorm M. Nellensteijn, Rachid Saouti |
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| Přispěvatelé: | VU University medical center, Orthopedic Surgery and Sports Medicine, Amsterdam Movement Sciences, AMS - Rehabilitation & Development |
| Rok vydání: | 2021 |
| Předmět: |
musculoskeletal diseases
medicine.medical_specialty Revision total knee arthroplasty Total knee arthroplasty Context (language use) Metaphyseal bone loss 03 medical and health sciences 0302 clinical medicine Case report medicine Femur Allograft bone impaction Impaction business.industry fungi food and beverages Periprosthetic osteolysis musculoskeletal system Surgery 030220 oncology & carcinogenesis 030211 gastroenterology & hepatology Implant Presentation (obstetrics) business Complication |
| Zdroj: | Rassir, R, Nellensteijn, J M, Saouti, R & Nolte, P A 2021, ' Bilateral massive osteolysis of uncertain origin after total knee arthroplasty: A case report and review of literature ', International Journal of Surgery Case Reports, vol. 80, 105678 . https://doi.org/10.1016/j.ijscr.2021.105678 International Journal of Surgery Case Reports, 80:105678. Elsevier BV International Journal of Surgery Case Reports |
| ISSN: | 2210-2612 |
| Popis: | Highlights • Osteolysis can occur in the patella without a patellar prosthesis. • Increased shelf-age and lower sterilization dose of inserts predispose for osteolysis. • Conventional radiographs lack sensitivity in detecting and monitoring osteolysis. • Insert exchange, implant anchorage/alignment and bone defects are surgical priorities. • Although bone defects can be massive, no total revision is needed with good anchorage. Introduction and importance Periprosthetic osteolysis (PPOL) is a common complication after total knee arthroplasty (TKA) and is most commonly caused by wear-induced particles. Case presentation We report an unusual case of massive bilateral PPOL in the posterior flanges of the femur and patellae 4 years after bilateral uncemented TKA without patellar resurfacing in a 71-year old female. Bilateral staged revision surgery including polyethylene exchange and allograft morselized bone impaction was performed to treat the osteolytic lesions. There were no signs of implant malalignment, polyethylene wear or component loosening. Clinical discussion Several factors are associated with an increased risk on PPOL (e.g. polyethylene sterilization method, patient age, male gender). Surgical intervention in the context of massive PPOL should include replacement of a potential particle generator (most often polyethylene), correction of potential malalignment, treatment of bone defects and assessment of implant anchorage. Conclusion This report highlights the available evidence on clinical presentation, associated risk factors and preferred treatment strategy of massive osteolytic lesions after TKA according to available evidence. |
| Databáze: | OpenAIRE |
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