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Revision Total Knee Arthroplasty due to Implant Instability 03
Case Report
Revision Total Knee Arthroplasty due to Implant Instability
Endorsed by: Dr. Brajesh Koushle, Consultant Orthopedic Surgeon, Noida
Background
Implant instability
Implant instability is the major contributing factor for revision surgery. The two underlying
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reasons include:
Instability in the aging implant 1
Young patients (< 65 years) receiving primary total knee arthroplasty (TKA) 2
The younger patient population is physically more active and thus has an increased risk for
wear-induced osteolysis and loosening of prosthesis due to immunological reactions. 3,4
Foreign body giant cell reaction
A rare phenomenon in knee arthroplasty. 5
Cells from the monocyte/macrophage lineage fuse to form giant cells and are the first cells in
our body to interact with the implanted biomaterials. 5
Most commonly observed at the interface of tissue and implanted material, such as knee
arthroplasty prosthesis in this case. 5
The primary function of giant cells is to degrade and reabsorb the underlying substrate.
Foreign body giant cells (FBGC) adhere primarily to synthetic surfaces unlike osteoclasts that
specifically targets the bone. 5
Osseointegration refers to our body’s responses against implant surfaces and is the direct
result of the foreign body reaction. Osseointegration is commonly observed in dental
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implants where a bone may grow over the implant surface. However, it has been rarely
reported in the context of knee arthroplasty. 6
Case Report
An 83-year-old female with bilateral primary TKA performed 17 years ago, was presented with
worsening left knee pain, gait instability, and swelling for three months duration. Until this point, she
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had been completely asymptomatic. 7