Thigh Mass and Lytic Diaphyseal Femoral Lesion Associated with Polyethylene Wear After Hybrid Total Knee Arthroplasty

Abstract

Osteolysis secondary to polyethylene wear can occur following total knee arthroplasty, but its presentation can be extremely variable1-7. We present the case of a patient who had an unusual biologic reaction to polyethylene wear that presented as a thigh mass and an extramedullary lytic diaphyseal femoral lesion thirteen years after hybrid total knee arthroplasty. The patient was informed that data concerning this case would be submitted for publication. Aseventy-one-year-old man presented with a six-month history of increasing pain and swelling in the left knee and distal part of the thigh. Thirteen years previously, in 1991, the patient had undergone a left total knee arthroplasty (PFC; Johnson and Johnson, Warsaw, Indiana) for the treatment of symptomatic osteoarthritis. At the time of that procedure, an uncemented cobalt-chromium cruciate-retaining porous-coated femoral component, a cemented titanium tibial tray, and a 10-mm posterior-lipped modular polyethylene insert were implanted. The patella was resur-faced with an all-polyethylene button. The patient did not return for regular follow-up despite numerous requests that he comply with our policy of annual patient evaluations. He reported that he had been asymptomatic until six months before the time of presentation, when he noted a painful swelling along the lateral aspect of the knee and the distal part of the anterior aspect of the thigh. He reported no history of fevers, chills, weight loss, or other constitutional symptoms. Physical examination revealed a thin, healthy-appearing man who walked with an antalgic gait. A moderate boggy effusion was noted around the left knee. He had full knee extension and active flexion to 110°. No gross instability of the knee was noted. There was no swelling of the distal part of the limb, and the neurovascular examination revealed normal findings. Moderately compressible nonpainful masses were present over the distal part of the anteromedial …