Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2023 Apr 26;15(4):e38143.
doi: 10.7759/cureus.38143. eCollection 2023 Apr.

Early Failure of Primary Total Knee Arthroplasty Due to Massive Osteolysis Caused by Bio-Absorbable Interference Screws

Mukund Reddy V Galiveeti  1 , Khaldoun El-Abed  1 , Riaz Ahmad  1
Affiliations
Case Reports

Early Failure of Primary Total Knee Arthroplasty Due to Massive Osteolysis Caused by Bio-Absorbable Interference Screws

Mukund Reddy V Galiveeti et al. Cureus. .

Abstract

We report an unusual case in which an unabsorbed bio-absorbable screw in the tibial tunnel of anterior cruciate ligament reconstruction (ACLR) performed 11 years ago caused massive osteolysis and subsequent failure of total knee arthroplasty (TKA). ACLR was performed using suspensory fixation on the femoral side and a bio-absorbable interference screw on the tibial side. Fragmentation of the bio-absorbable screw at the time of tibial component implantation is thought to have evoked an accelerated inflammatory response, causing osteolysis, which finally resulted in early failure of the TKA.

Keywords: anterior cruciate ligament reconstruction; bio-absorbable; interference screws; osteolysis; total knee arthroplasty.

PubMed Disclaimer

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Radiographs of the right knee done in December 2014. Lateral (left) and antero-posterior (right) views showing the tibial and femoral tunnels with a suspensory fixation on the femoral side.
Figure 2
Figure 2. Post-operative radiographs done in February 2016. Antero-posterior (left) and lateral (right) radiographs following primary knee arthroplasty.
Figure 3
Figure 3. Series of radiographs depicting progressive osteolysis. Osteolysis in comparison depicted by an arrow on antero-posterior radiographs taken in (A) February 2016, (B) July 2017 and (C) June 2019.
Figure 4
Figure 4. Long leg alignment radiograph before planning revision total knee replacement. The mechanical axis is depicted by the green line drawn from the centre of the femoral head to the centre of the ankle joint.
Figure 5
Figure 5. CT scan images. Depicting osteolysis around the tibial component in nine coronal and sagittal views indicated by arrows around the tibial stem.
CT, computed tomography
Figure 6
Figure 6. Post-operative radiographs following revision total knee arthroplasty. Antero-posterior (left) and lateral (right) views done in November 2019.
Figure 7
Figure 7. Intraoperative finding showing a fragmented bio-composite screw. The bio-absorbable screw was still present even after years of implantation.
See this image and copyright information in PMC

References

    1. Long-term followup of anatomic graduated components posterior cruciate-retaining total knee replacement. Ritter MA, Berend ME, Meding JB, Keating EM, Faris PM, Crites BM. https://pubmed.ncbi.nlm.nih.gov/11451132/ Clin Orthop Relat Res. 2001:51–57. - PubMed
    1. Does prior anterior cruciate ligament reconstruction affect outcomes of subsequent total knee arthroplasty? A systematic review. Chaudhry ZS, Salem HS, Purtill JJ, Hammoud S. https://pubmed.ncbi.nlm.nih.gov/31321251/ Orthop J Sports Med. 2019;7:2325967119857551. - PMC - PubMed
    1. Bioabsorbable screws, whatever the composition, can result in symptomatic intra-osseous tibial tunnel cysts after ACL reconstruction. Chevallier R, Klouche S, Gerometta A, Bohu Y, Herman S, Lefevre N. https://pubmed.ncbi.nlm.nih.gov/29961095/ Knee Surg Sports Traumatol Arthrosc. 2019;27:76–85. - PubMed
    1. Clinical complications of biodegradable screws for ligament injuries. Ramos DM, Dhandapani R, Subramanian A, Sethuraman S, Kumbar SG. Mater Sci Eng C Mater Biol Appl. 2020;109:110423. - PubMed
    1. Pre-tibial reaction to biointerference screw in anterior cruciate ligament reconstruction. Ramsingh V, Prasad N, Lewis M. Knee. 2014;21:91–94. - PubMed

Publication types