Late hemorrhagic pseudoseptic arthritis encountered during total knee arthroplasty due to hyaluronic acid viscosupplementation

Abstract

Osteoarthritis (OA) is the most common form of arthritis and affects approximately one-third of people in the United Sates aged 65 years and older. Since 2013, the American Academy of Orthopaedic Surgeons has not been able to recommended using hyaluronic acid for patients with symptomatic OA of the knee. Subsequent publications have also cautioned against the use of viscosupplementation based on lack of efficacy and the potential for harm. We present a case of late hemorrhagic pseudoseptic arthritis encountered during TKA due to hyaluronic acid viscosupplementation. Our triad of findings includes (1) acute and chronic inflammatory cells on frozen section, (2) synovitis with hemosiderin deposition, and (3) blackened cartilage with iron deposition on permanent histopathology. Our case is unique in that it shows a previously undescribed late complication of viscosupplementation.

Hyaluronic Acid Injections for Knee Osteoarthritis

“…Although a large volume of systematic reviews and meta-analyses continue to be published exploring this topic 12 , adequately blinded randomized controlled trials (RCTs) have failed to demonstrate any clinically important benefit from HA compared with placebo 21 . Conversely, there is some evidence that preoperative HA use may increase the risk of various adverse outcomes among patients subsequently undergoing TKA, such as acute inflammatory reactions 22,23 and periprosthetic joint infection 24 . Therefore, our findings regarding a significant rise in HA-related costs in the setting of nonsignificant changes in utilization rates serve to reaffirm the need for further interventions aimed at limiting this low-value orthopaedic care 6,12,25 .…”

Transfer RNAs-derived small RNAs and their application potential in multiple diseases

“…It can ruin any joint, especially the knee, hip, spine and upper limb joints ( Zacharjasz et al, 2021 ). As reported by United Nations, an estimated of 15% of the global populations who are over 60 will have symptomatic OA and one-third of these people will be eventually disabled, which means by 2050, 130 million people will suffer from OA globally and 40 million of them will be severely disabled ( Korsh et al, 2016 ).…”