Title : Giant calf mass as a late manifestation of Total Knee Arthroplasty(TKA) failure- A case report and surgical approach
Abstract:
Aim: To report a rare case of a massive calf swelling as a late complication of total knee arthroplasty (TKA), highlighting the role of polyethylene wear-induced osteolysis and the surgical approach for management.
Study Setting: A 75-year-old male, three years post-primary TKA, presented with a progressively enlarging, painless swelling in the popliteal and calf region. Clinical examination revealed a large, cystic, non-pulsatile mass with mild knee effusion. Radiological investigations confirmed periprosthetic osteolysis, component loosening, and a large synovial cyst extending into the calf.
Discussion: A two-stage surgical approach was undertaken. The first stage involved cyst excision via a posteromedial approach, revealing a polyethylene wear debris-induced inflammatory response. Microbiological evaluation was negative, and histopathology confirmed a foreign body reaction without infection. Following soft tissue healing, the second stage involved revision TKA with distal femoral replacement and tibial reconstruction. At one-year follow-up, the patient had pain-free knee function with no cyst recurrence.
This case underscores the importance of long-term follow-up after TKA to detect early signs of wear-induced osteolysis. Synovial cyst formation should be considered a potential marker of underlying prosthesis failure, warranting timely intervention to prevent extensive bone loss and complex revisions.
