Abstract
Introduction: Short term pain or discomfort after a knee replacement (TKR) is not uncommon, and is usually attributed to the surgical procedure. In this case report, we describe an unusual cause of knee pain following total knee replacement, and remind the reader of the need for a thorough assessment.
Case Report: A 76 year-old male presented with pain in the knee and shin seven months following a TKR on the same side. The pain was dull, aching and constant in nature. There was no other significant past medical history. Pre-operative and immediate postoperative radiographs did not reveal any other abnormality. Clinical examination revealed no evidence of infection, and the motion in the knee ranged from 0–100 degrees. Radiographs revealed a lytic lesion in the proximal tibia just distal to the tibial prosthesis. Further investigations confirmed a diagnosis of renal carcinoma with bone metastases, with one of the lesions appearing in the proximal tibia. The lesion was treated with intralesional curettage, cementing and plate osteosynthesis. The knee pain improved and the mobility was restored. Follow-up radiographs at 6 months showed no evidence of local recurrence.
Discussion: Knee pain following TKR may be attributed to the surgery or the knee implant. However, it is important to keep an open mind about the diagnosis. Local hyperaemia in the metaphysis of proximal tibia following TKR may have resulted in the seeding of metastasis. We elected for primary stabilization of the metastasis with cement and plate, rather than revision of the tibial component with a long intramedullary stem. As a result, rehabilitation was rapid and the risks of revision of the knee prosthesis were avoided.
The abstracts were prepared by Mrs Leslie O’Leary. Correspondence should be addressed to her at British Orthopaedic Association, 35–43 Lincoln’s Inn Fields, London WC2A 3PE or at l.oleary@boa.ac.uk
