77F chronic pain on ambulation after TKA Nov 21 in another country, MRI, Please Help

I received one very helpful response from Tatiane Cantarelli:

It seems to me that the type of prosthesis has a box cut into the femoral
component (not a peg) in the intercondylar notch. In my opinion it’s not
osteolysis, but some fluid in this area, like a recess.

[image: image.png]

[image: image.png]

So I will not report this as osteolysis or infection.
I haven’t seen the bone scan….and I would defer to a nuclear medicine
imager…but I do know that you can have persistent uptake related to
surgery up to a year….and this is 1 year (and I don’t know how long ago
the bone scan was performed).
The fact remains, the patient has had limiting pain since the arthroplasty.
Tatiane pointed out the scarring in the anterior notch as a possible pain
generator….which I had discounted, because prior cases of symptomatic
scarring I had seen were much more exuberant.

My plan is to contact the referrer and see if it would help to inject
anesthetic and steroid, to see if this might help determine if that
scarring is causing symptoms.
It also occurred to me that there might be rotational malalignment of the
components….which I cannot evaluate (as the axial images are
non-diagnostic)….I can offer a CT if this is considered a possibility.

Thanks to Tatiane for all of her help.

Hilary

[gallery]