Periosteal pseudotumor in complex total knee arthroplasty resembling a neoplastic process

• 作者: Edward J McPherson Madhav Chowdhry Matthew V Dipane
• 来源期刊: 世界骨科杂志
• 学科: 医学
• 关键词: PSEUDOTUMOR Total knee ARTHROPLASTY Metallic wear DEBRIS LOOSE IMPLANT
• 年，卷（期）: 2018,（5）
• 页码范围: 72-77
• 页数: 6页
• 分类号: R

摘要

This case report describes in detail an erosive distal diaphyseal pseudotumor that occurred 6 years after a complex endoprosthetic hinge total knee arthroplasty(TKA).A female patient had conversion of a knee fusion to an endoprosthetic hinge TKA at the age of 62.At her scheduled 6-year follow-up,she presented with mild distal thigh pain and radiographs showing a 6-7 cm erosive lytic diaphyseal lesion that looked very suspicious for a neoplastic process.An en bloc resection of the distal femur and femoral endoprosthesis was performed.Histologic review showed the mass to be a pseudotumor with the wear debris emanating from within the femoral canal due to distal stem loosening.We deduce that mechanized stem abrasion created microscopic titanium alloy particles that escaped via a small diaphyseal crack and stimulated an inflammatory response resulting in a periosteal erosive pseudotumor.The main lesson of this report is that,in the face of a joint replacement surgery of the knee,pseudotumor formation is a more likely diagnosis than a neoplastic process when encountering an expanding bony mass.Thus,a biopsy prior to en bloc resection,would be our recommended course of action any time a suspicious mass is encountered close to a TKA.