A Case of Aseptic Loosening Secondary to Cement Debris

Particulate wear is a well-established cause of aseptic loosening and failure in joint arthroplasty. We aim to describe a case of cement-induced synovitis with the deposition of cement debris causing a distinct green-hued synovitis in a case of primary total knee arthroplasty (TKA). A 61-year-old lady presented to our clinic with right knee pain and swelling after undergoing bilateral total knee replacement four years ago at another institution. She was initially worked up by her primary surgeon and was symptomatically treated with non-steroidal anti-inflammatory medication (NSAID). However, her symptoms persisted and impaired her daily function. She presented with right knee effusion and decreased range of motion of the knee, as well as joint line tenderness. Further radiological investigations showed right knee tibial component implant loosening, with bone cement fragments in the anterior tibia. As such, the patient was counselled and underwent a revision surgery. Intraoperatively, there was extensive synovitis with prominent green pigment deposits. Excessive cement was noted in the femoral notch, causing wear of the liner pole. The tibia tray was also found to be loose, with no cement adherent to the tibia tray, and all the cement mantle seated on the tibia bone. Postoperatively, the patient made an uneventful recovery. She was able to range her knee from 10-130 degrees with no pain within 2 months. Direct wear from residual cement and micromotion at the tibia tray due to poor cementing technique during the primary surgery were important factors leading to severe cement wear and failure. This clinical case is a reminder of the importance of good cementing technique to ensure a good outcome in TKA.