Osteolysis associated with cemented total knee arthroplasty. A case report

Area of Science:

• Orthopedic surgery
• Biomaterials science
• Bone biology

Background:

• Osteolysis, or bone loss, is a known complication following cementless total knee arthroplasty, typically occurring within five years.
• The bone-cement interface in cemented total knee arthroplasty was thought to prevent polyethylene debris migration, thus inhibiting osteolysis.
• Previous literature has not reported osteolysis as a significant issue after cemented total knee arthroplasty.

Observation:

• A 75-year-old female patient presented with osteolysis nine years after undergoing cemented total knee arthroplasty.
• The observed osteolytic lesion was located in the vicinity of the cemented total knee arthroplasty implant.
• Synovium and particulate debris were surgically removed from the affected area.

Findings:

• The osteolytic area demonstrated significant bone regeneration and a return to normal bone architecture three years post-intervention.
• Implant revision surgery was not required to achieve this bone healing.
• This case challenges the established understanding of osteolysis progression in cemented total knee arthroplasty.

Implications:

• Osteolysis can occur late after cemented total knee arthroplasty, contrary to previous assumptions.
• Surgical debridement of polyethylene particles and inflamed synovium may be a viable conservative treatment for late osteolysis.
• Further research is warranted to understand the mechanisms of late osteolysis and the efficacy of non-revision interventions.