Dissecting or ruptured popliteal cysts occur most frequently as
a result of intra-articular knee pathology. Dissecting popliteal
cyst after total knee arthroplasty is a rare occurrence. It has
been reported that the cyst was associate with a failed total
knee arthroplasty(TKA) related to polyethylene wear particles
or prosthesis loosening. Occasionally prosthetic loosening
is difficult to be differentiated from a post-TKA infection.
We report a case of popliteal cyst complicated by popliteal
fistula resulting from prosthetic loosening, which was difficult
to be differentiated from a post-TKA infection.
The patient, a 77-year-old man, underwent Lt TKA 10 years
ago with a diagnosis of OA by another physician. Ten days after
surgery, symptoms suggestive of a postoperative infection,
such as swelling and local heat of the left knee, developed.
Administration of an antibiotic brought the condition to a quiescent
state. Six months after surgery, the swelling and local
heat returned to the left knee; and this time the patient was
subjected to arthroscopic synovectomy. Candida was isolated
from the specimen obtained during the surgical procedure.
Although he had been free of the symptoms since then, 4
years after surgery the arthritic symptoms recurred. Plain radiograms
showed osteolytic lesions at the distal femur, medial
side of the proximal tibia, and patella. The pain exacerbated.
A fistula had formed at the popliteal region with a discharge.
The patient was referred to us for further examination and
treatment.
A physical examination revealed swelling, slight local heat,
and joint effusion of the left knee joint. The range of motion
was 0 ~ 110°. An articular puncture yielded a bloody joint fluid
but the results from a bacterial culture were negative. The
popliteal region was slightly erythematous and locally feverish
and had formed two fistulas, which were exudative.
The patient, a 77-year-old man, underwent Lt TKA 10 years
ago with a diagnosis of OA by another physician. Ten days after
surgery, symptoms suggestive of a postoperative infection,
such as swelling and local heat of the left knee, developed.
Administration of an antibiotic brought the condition to a quiescent
state. Six months after surgery, the swelling and local
heat returned to the left knee; and this time the patient was
subjected to arthroscopic synovectomy. Candida was isolated
from the specimen obtained during the surgical procedure.
Although he had been free of the symptoms since then, 4
years after surgery the arthritic symptoms recurred. Plain radiograms
showed osteolytic lesions at the distal femur, medial
side of the proximal tibia, and patella. The pain exacerbated.
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