Abstracts Posters SICOT-SOF meeting Gothenburg 2010 _2_

Poster
Topic: Arthroplasty - Knee
Abstract number: 26574
SEVERE PERSISTENT SYNOVITIS AFTER COBALT - CHROMIUM TOTAL KNEE
REPLACEMENT REQUIRING REVISION SURGERY
Raman THAKUR 1 , Michael MCGRAW 2 , Michael PARKS 2 , Mathais BOSTRUM 2 , Jose
RODRIGUEZ 3
1 William Harvey Hospital, Ashford (UNITED KINGDOM), 2 Hospital for Special
Surgery, New York (UNITED STATES), 3 Lenox Hill Hospital, New York (UNITED
STATES)
Implant related hypersensitivity is an infrequent complication after total knee
replacement. It remains a relatively unpredictable and poorly understood cause of
failure of an implant. We present a report of five patients who presented with
persistent hypertrophic synovitis after total knee replacement using a cobalt chrome
component. Extensive preoperative and intraoperative attempts ruled out infection as
a cause of symptoms. The knees had good ligamentous balance and were well
aligned and fixed. The clinical condition improved after revision to a zirconium
femoral and titanium metal backed tibial components. Intraoperative histopathology
revealed thickened synovium with a predominantly monocellular (lymphocytic or
histiocytic) response. Where infection and instability have been excluded as a cause
of persistent pain and swelling, consideration should be given to metal allergy as a
cause of failure in primary knee replacement surgery.
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