Massive osteolysis due to galvanic corrosion after total knee arthroplasty: a rare cause for early revision?

Early Failure of Primary Total Knee Arthroplasty Due to Massive Osteolysis Caused by Bio-Absorbable Interference Screws

We report an unusual case in which an unabsorbed bio-absorbable screw in the tibial tunnel of anterior cruciate ligament reconstruction (ACLR) performed 11 years ago caused massive osteolysis and subsequent failure of total knee arthroplasty (TKA). ACLR was performed using suspensory fixation on the femoral side and a bio-absorbable interference screw on the tibial side. Fragmentation of the bio-absorbable screw at the time of tibial component implantation is thought to have evoked an accelerated inflammatory response, causing osteolysis, which finally resulted in early failure of the TKA.

An Interesting Case of Osteolysis With Accompanying Metallosis in a Primary Total Knee Arthroplasty

Arthroplasty implants are comprised of metal alloys designed to function within the human body. Implant-related issues and associated soft-tissue reactions have been well documented for modular revision hip and knee constructs. This case highlights findings of metallosis in the context of polyethylene wear in a failed primary total knee arthroplasty. Fretting of a polyethylene reinforcement pin within the tibial baseplate as a direct result of knee joint instability appears to be the root cause of observed periprosthetic metallosis. Enhanced design principles and improved polyethylene locking mechanisms may be useful to potentially mitigate fretting-related issues in future knee replacement designs. The authors recommend surveillance in patients with this construct especially when prosthetic instability is present.

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

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.