I have the last clinical visit note.
Labs including ESR, CRP and WBC are normal.
I have no XRs or other imaging.
Outside Bone Scan reported as “findings may be consistent with loosing of
the femoral component”
[image: 77F chronic pan p TKA Nov 21.jpg]
I am concerned about the smooth “bone loss” above and anterior to the peg
of the femoral component in the notch.
I consulted a colleague who thought that it might be normal since it
correlates with the contour of the peg and, especially, because there is no
dark signal to suggest metal debris, and little fluid signal distention of
the joint.
I was not aware that either is a requirement for osteolysis….is it?
[image: 77F chronic pan p TKA Nov 21 (1).jpg]
There is no marrow signal abnormality and no soft tissue mass.
Sadly the axial PD and T1 (not MAVRIC) images are essentially a blackout.
I cannot begin to see contours of the components to measure possible
rotatory malalignment.
This is only 1 year post arthroplasty.
The patient had Right TKR just 3 months prior and that knee is asymptomatic.
It’s early for Osteolysis.
Could be in the time window for indolent infection, but I would expect
signal changes in the bone and more fluid (I think)….I suspect labs could
be surprisingly normal?
1 thought on “77F chronic pain on ambulation after TKA Nov 21 in another country, MRI, Please Help”
hilary.umans
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.
77F-chronic-pan-p-TKA-Nov-21.pptx
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
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