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Revision Total Knee Arthroplasty due to Implant Instability 05

Postoperative Observations 7 five years, biennial for years 6-10, and then Macrophages, Foreign Body Giant Cells and Their
A B
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
patient. The present case report highlights the 7) Cantrell CK, Patel HA, Stroud WR, et al. A Case Report

Discharge: Day 2 postoperatively importance of long-term follow up, especially of Revision Total Knee Arthroplasty After 17 Years: All
in younger patient population for early Grown Up, What Happens When Implants Mature?

Figure 1: (a) Intraoperative images depicting (a) Follow up after two weeks 7 diagnosis of implant failure and to avoid more
removal of previous total knee arthroplasty (TKA) Cureus. 2018;10(6):e2797. doi:10.7759/cureus.2797
components (b) bone ingrowth on femoral component Pain was well controlled complex revision surgeries that are highly
of the previous implant 7
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

Long-term reaction at bone-cement interface be in correct position with no evidence of References: arthroplasty: results of the American Association of Hip
led to engulfing of cement and direct ingrowth hardware malfunction or loosening. and Knee Surgeons' member survey. J Arthroplasty.

of bone to implant. 1) Singh J, Politis A, Loucks L, Hedden DR, Bohm ER. 2003;18(8):954-962. doi:10.1016/j.arth.2003.09.001
7
Outcome Trends in revision hip and knee arthroplasty observations

Histological assessment The patient provided positive review on her after implementation of a regional joint replacement
Papillary synovial proliferation in agreement new prosthesis. 7 registry. Can J Surg. 2016;59(5):304-310.
doi:10.1503/cjs.002916
with patient’s history of osteoarthritis. 7
Multiple FBGCs formed by fused Operative pearls for surgery 2) Bayliss LE, Culliford D, Monk AP, et al. The effect of

macrophages were observed in response to The underlying mechanism of FBGCs patient age at intervention on risk of implant revision after
polarizable foreign material. 7 reaction on prostheses and hydroxyapatite total replacement of the hip or knee: a population-based

cement remains elusive and requires further cohort study Lancet. 2017;389(10077):1424-1430.
Diagnosis and procedure doi:10.1016/S0140-6736(17)30059-4
research.
Chronic inflammation and FBGC reaction due

to orthopaedic implants were confirmed 3) Clohisy JC, Kamath GV, Byrd GD, Steger-May K, Wright
Patients may remain asymptomatic for FBGC
(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
period, and by the time symptoms arise, 2008;90(9):1848-1854. doi:10.2106/JBJS.G.00856
components were performed as per standard
already an extensive damage to the
technique. 7
periprosthetic bone may have occurred. 4) Neale SD, Athanasou NA. Cytokine receptor profile of
2
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.
7
Extensive osteophytes around the patella ingrowth, which had encased the patella Figure 2: High resolution photomicrographs of doi:10.1097/MOH.0b013e32831ac52e
hematoxylin and eosin (H&E) stained sample showing Surgeons (AAHKS) recommends to pursue
were removed and a medial release was (Figure 1b). 7 (a) multiple foreign body giant cells in response to an annual radiological follow up for the first
polarizable foreign material, (b) multiple polarizable 6) Sheikh Z, Brooks PJ, Barzilay O, Fine N, Glogauer M.
performed, to facilitate removal of previous foreign material being engulfed by giant cells 7