Niki Yasuo, Matsumoto Hideo, Otani Toshiro, Yoshimine Fumihiro, Inokuchi Wataru, Morisue Hikaru
Department of Orthopaedic Surgery, Tokyo Metropolitan Ohkubo Hospital, Tokyo, Japan.
J Arthroplasty. 2003 Dec;18(8):1071-5. doi: 10.1016/s0883-5403(03)00328-0.
We present a case exhibiting persistent joint effusion and formation of a gigantic popliteal synovial cyst 8 years after total knee joint arthroplasty. Assessment using flow cytometry revealed that both joint and cyst fluid contained abundant macrophage-phagocytosing wear particles. This finding indicates that wear particles participated in formation of the cyst through the communication between the joint cavity and cyst. Intraoperatively, prominent villous synovial proliferation was observed in both the joint and cyst, and delamination failure of the polyethylene insert was identified. Because no evidence of prosthetic loosening was found, only polyethylene insert revision and synovectomy were undertaken, resulting in a successful outcome. This case suggests that synovial cyst formation in popliteal lesions might represent a sign of wear-particle generation after total knee joint arthroplasty.
我们报告一例全膝关节置换术后8年出现持续性关节积液并形成巨大腘窝滑膜囊肿的病例。流式细胞术评估显示，关节液和囊肿液中均含有大量吞噬磨损颗粒的巨噬细胞。这一发现表明，磨损颗粒通过关节腔与囊肿之间的连通参与了囊肿的形成。术中，在关节和囊肿中均观察到明显的绒毛状滑膜增生，并发现聚乙烯内衬分层失败。由于未发现假体松动的证据，仅进行了聚乙烯内衬翻修和滑膜切除术，结果成功。该病例提示，腘窝病变中滑膜囊肿的形成可能代表全膝关节置换术后磨损颗粒产生的一个迹象。
