Iliotibial band enthesopathy: an unusual cause of lateral knee pain post total knee replacement

Iliotibial band friction syndrome after knee cementoplasty: a case report

Iliotibial band pathologies can result in lateral knee pain. These are commonly seen in runners and cyclists. Lateral knee pain following knee arthroplasty can be due to distal iliotibial band enthesopathy or impingement by the femoral component. Cementoplasty is a common procedure performed during treatment of osseous lesions. We describe a case of ITB friction syndrome due to small focus of cement following cementoplasty for GCT (giant cell tumour).

Diagnostic ultrasound and ultrasound-guided injections for peri-articular pain after knee replacement

OBJECTIVE

The purpose of this technical report is to review the sonographic spectrum of abnormalities accounting for peri-articular pain after knee replacement surgery, as well as to demonstrate the clinical utility of ultrasound in the diagnosis and treatment of this subset of patients.

MATERIALS AND METHODS

Utilizing an imaging report database, we performed a search for ultrasound examinations performed by a single radiologist for knee pain after knee arthroplasty at our institution over a 10-year period. The search yielded 63 patients, whom we have categorized by causative pathology, with representative diagnostic and procedural ultrasound images selected for inclusion.

RESULTS

Our search yielded multiple causes of peri-articular knee pain after arthroplasty, including medial and lateral retinacular impingement and scarring, iliotibial band or conjoined tendon irritation, popliteus tendon impingement, medial collateral ligament impingement, pes anserine bursitis, and scarring of Hoffa's fat pad.

CONCLUSION

While knee arthroplasty is an often-successful procedure, it can be complicated by post-operative peri-articular knee pain. Ultrasound provides a valuable tool for the diagnosis of painful peri-articular knee pathology, as it allows for both static and dynamic evaluation, as well as direct correlation with patient symptoms, and is not confounded by the metal components. In addition to its diagnostic utility, ultrasound can also guide diagnostic and/or therapeutic injections of anesthetic and corticosteroid. Given these advantages, ultrasound is an important tool in managing the painful post-arthroplasty knee.