Large Soft-tissue Mass Formation After Revision Total Knee Arthroplasty: An Unusual Case of Adverse Reaction to Metal Debris and Review of the Literature

Abstract

We report about the rare case of a patient who developed large soft-tissue mass formations related with revision total knee arthroplasty which was implanted 4 years prior. Owing to suspected periprosthetic joint infection, the prosthesis was removed and the lesions were resected, resulting in severe soft-tissue loss and temporary arthrodesis using a poly(methyl methacrylate) spacer. Histological analysis revealed a type VI periprosthetic membrane. The situation was further complicated by wound infection requiring multiple revision surgeries. After discussion and evaluation of the available treatment options, the decision for an above-the-knee amputation was made. The tissue reaction resulting in these soft-tissue lesions is referred to as an “adverse local tissue reaction.” Wear-induced lesions after total knee arthroplasty, especially of this magnitude, are very rare and difficult to treat.

Systemic Metal Ion Concentrations in Patients With Hip and Knee Megaprostheses: A Prospective Cohort Study

“…The levels of Ag in the blood of patients with and without argyria were comparable. Although no other cases of adverse local tissue reaction were found in our patients, pseudotumor formation in patients with MoM THAs and TKAs have been documented in other studies and case reports [ 6 , 25 , 26 ]. Sutphen et al.…”