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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
                                                                                        1
               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
                                                        6
                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
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