An impinging remnant meniscus causing early polyethylene failure in total knee arthroplasty: a case report

Rachid Saouti,Christiaan M Fortanier,Barend J Van Royen

doi:10.1186/1752-1947-1-48

Rachid Saouti, Christiaan M Fortanier + Show 1 more

Open Access

https://doi.org/10.1186/1752-1947-1-48

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Journal: Journal of medical case reports	Publication Date: Jul 13, 2007
Citations: 15	License type: cc-by

Affiliation: Amsterdam UMC Location VUmc

Abstract

The management of patients with an apparently normal functional total knee arthroplasty (TKA) suffering from unexplained persistent pain and swelling is a challenging issue. The usual causes of pain after total knee replacement are well known, but there are a small number of patients in whom its aetiology is obscure. Malfunction due to soft tissue impingement has rarely been reported. A patient with an unusual case of posterior soft tissue impingement secondary to a trapped posterior horn of a remnant medial meniscus after TKA and responsible for severe early polyethylene wear, is reported. The diagnosis was confirmed by arthroscopy. Treatment was performed by arthrotomy. The meniscus remnant was removed followed by total synovectomy and isolated exchange of the polyethylene insert. To our knowledge, this is the first well-documented case reporting this association.

Highlights

A 63-year old male patient with a history of symptomatic osteoarthritis of the left knee underwent a Total Knee Arthroplasty (TKA) of posterior cruciate ligament retaining design (Kinemax, Stryker, Mahwah, New Jersey, USA) without a patella component
Standard radiographs showed a well-aligned TKA with no signs of loosening or polyethylene wear (Figure 1)
Arthroscopy revealed a remnant of the posterior horn of the medial meniscus impinging between the posterior part of the femoral component and the polyethylene insert

Summary

Introduction

A 63-year old male patient with a history of symptomatic osteoarthritis of the left knee underwent a Total Knee Arthroplasty (TKA) of posterior cruciate ligament retaining design (Kinemax, Stryker, Mahwah, New Jersey, USA) without a patella component. The patient developed increasing pain and complained of "catching" of the knee. Standard radiographs showed a well-aligned TKA with no signs of loosening or polyethylene wear (Figure 1). A technetium 99m diphosphonate bone scintigraphy showed an increased perfusion in the early phase and increased uptake in the static phase at the medial side of the femoral and tibial component and in the patella of the left knee (Figure 2).

Results

Conclusion