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Complications of Orthopaedic Surgery

Atkinson HD, Ranawat VS, Oakeshott RD. J Orthop Surg Res 2010;5:29.

This report gives an insight into a minimally invasive technique for debridement and grafting of polyethylene-related granuloma and osteolysis in an uncemented total knee arthroplasty patient in whom revision surgery was unsuitable.

 

Polyethylene has been known for some time to produce debris that may lead to periprosthetic osteolysis following total knee arthroplasty. When large defects are present or in the presence of granulomatous change, and when knee function has deteriorated, open revision surgery is the gold standard, which can lead to substantial bone loss. In the current case, owing to significant medical comorbidities, the surgical team opted for percutaneous debridement of granulomatous tissue, followed by grafting of the bony defect caused by polyethylene-related osteolysis. An injectable calcium phosphate bone graft substitute was used to fill a large medial femoral condylar defect, measuring 16 cm3, and a further defect in the proximal tibia measuring 3.6 cm3.

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