Primary Total Knee Arthroplasty for Bullet-Induced Lead Arthropathy

Gunshot injuries to the knee are uncommon but may lead to unique long-term complications when intra-articular bullets are not removed. While the management of retained bullets may be challenging, there is the grave risk of developing lead toxicity and local joint destruction from exposure to synovial fluid. We report the case of a 55-year-old man who presented with lead toxicity 20 years after a gunshot injury to his knee. Imaging revealed advanced osteoarthritis with a characteristic "lead arthrogram," and laboratory tests confirmed elevated serum lead levels. He was successfully treated with chelation therapy followed by definitive surgical intervention, including radical synovectomy and total knee arthroplasty. This case highlights the importance of multidisciplinary care when managing delayed lead toxicity and arthropathy in patients with retained intra-articular bullets.