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Postoperative Observations 7 five years, biennial for years 6-10, and then Macrophages, Foreign Body Giant Cells and Their
Clinical Profile 7 Excellent placement of a left knee either annual or biennial for the years Response to Implantable Biomaterials. Materials (Basel).
arthroplasty as confirmed by X-ray scans. thereafter. 8 2015;8(9):5671-5701. Published 2015 Aug 28.
doi:10.3390/ma8095269
No postoperative complications reported in
Presenting symptoms patient. The present case report highlights the 7) Cantrell CK, Patel HA, Stroud WR, et al. A Case Report
Sharp, steadily worsening pain specifically localized to left knee joint Discharge: Day 2 postoperatively importance of long-term follow up, especially of Revision Total Knee Arthroplasty After 17 Years: All
Associated swelling that worsened with ambulation or prolonged standing in younger patient population for early Grown Up, What Happens When Implants Mature?
Conservative management did not improve pain and swelling Follow up after two weeks 7 diagnosis of implant failure and to avoid more Cureus. 2018;10(6):e2797. doi:10.7759/cureus.2797
Daily activities were steadily getting restricted Pain was well controlled complex revision surgeries that are highly
Occasional falls due to the perceived instability of knee joint Physical therapy was well followed laborious and costly for the patients. 7 8) Teeny SM, York SC, Mesko JW, Rea RE. Long-term
Gross visual inspection X-ray scan showed left knee arthroplasty to follow-up care recommendations after total hip and knee
Diagnosis be in correct position with no evidence of References: arthroplasty: results of the American Association of Hip
a) Physical examination: Long-term reaction at bone-cement interface and Knee Surgeons' member survey. J Arthroplasty.
led to engulfing of cement and direct ingrowth hardware malfunction or loosening.
A mild antalgic gait and tenderness over proximal tibia 1) Singh J, Politis A, Loucks L, Hedden DR, Bohm ER. 2003;18(8):954-962. doi:10.1016/j.arth.2003.09.001
of bone to implant.
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b) Culture tests Outcome Trends in revision hip and knee arthroplasty observations
Infection was ruled out by few benign inflammatory cells and negative after implementation of a regional joint replacement
Histological assessment The patient provided positive review on her
culture results. registry. Can J Surg. 2016;59(5):304-310.
Papillary synovial proliferation in agreement new prosthesis. 7
c) X-ray scan doi:10.1503/cjs.002916
with patient’s history of osteoarthritis. 7
Loosening and wear of implant based on following observations: Operative pearls for surgery
Multiple FBGCs formed by fused 2) Bayliss LE, Culliford D, Monk AP, et al. The effect of
The size and number of osteochondral bodies in the left
macrophages were observed in response to The underlying mechanism of FBGCs patient age at intervention on risk of implant revision after
suprapatellar recess were increased
polarizable foreign material. 7 reaction on prostheses and hydroxyapatite total replacement of the hip or knee: a population-based
Left joint effusion
cement remains elusive and requires further cohort study Lancet. 2017;389(10077):1424-1430.
Lysis and subsidence of the tibial component Diagnosis and procedure research. doi:10.1016/S0140-6736(17)30059-4
Decline in thickness of the component Chronic inflammation and FBGC reaction due
d) Bilateral knee bone scan to orthopaedic implants were confirmed Patients may remain asymptomatic for FBGC 3) Clohisy JC, Kamath GV, Byrd GD, Steger-May K, Wright
Implant loosening was confirmed with polyethylene wear and instability. (Figure 2 a, b). 7 RW. Patient compliance with clinical follow-up after total
reactions in response to implants for a long joint arthroplasty. J Bone Joint Surg Am.
Component removal and revision of knee
Management period, and by the time symptoms arise, 2008;90(9):1848-1854. doi:10.2106/JBJS.G.00856
Both surgical and non-surgical options were discussed with the patient. components were performed as per standard already an extensive damage to the
technique. 7 2
The patient elected to undergo revision surgery of left knee arthroplasty. periprosthetic bone may have occurred. 4) Neale SD, Athanasou NA. Cytokine receptor profile of
Therefore, clinical symptoms should be arthroplasty macrophages, foreign body giant cells and
preceded by radiologic assessment of mature osteoclasts. Acta Orthop Scand.
implant failure. 2 1999;70(5):452-458. doi:10.3109/17453679909000980
Surgery
A medial parapatellar arthrotomy was components (Figure 1a). 7 Future considerations 5) Brodbeck WG, Anderson JM. Giant cell formation and
performed , The femoral component showed bone The American Association of Hip and Knee function. Curr Opin Hematol. 2009;16(1):53-57.
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Extensive osteophytes around the patella ingrowth, which had encased the patella Surgeons (AAHKS) recommends to pursue doi:10.1097/MOH.0b013e32831ac52e
were removed and a medial release was (Figure 1b). 7 an annual radiological follow up for the first 6) Sheikh Z, Brooks PJ, Barzilay O, Fine N, Glogauer M.
performed, to facilitate removal of previous
