Huge calf swelling associated with a failed total knee replacement: A case report

Abstract

In patients who have undergone a total knee arthroplasty (TKA), any swelling occuring in or adjacent to the joint needs thorough investigation and a wear debris-induced cyst or pseudotumor should be suspected. Case History: A 75-year-old man, who underwent primary TKA for osteoarthritis three years back, presented with a swelling in the popliteal fossa extending into calf region of his left knee. Radiographs showed medial space narrowing, component loosening and osteolysis. Magnetic resonance imaging showed a popliteal cyst communicating with the knee joint and extending into the calf. A two stage procedure was done, excision of cyst followed by revision TKA after three weeks. At one year follow-up, the patient had a painless knee without cyst recurrence. Conclusion: Long term follow-up is critical for patients with TKA for early detection of occult polyethylene wear and prosthesis loosening. Joint effusion and synovial cyst formation should be considered a preceding sign of periprosthetic osteolysis.