Tibial Component Revision Arthroplasty Using Porous Tantalum Cone for Symptomatic Progressive Periprosthetic Proximal Tibial Ganglion Cyst about All-Polyethylene Tibia Primary Total Knee Replacement: A Case Report and Review of Literature

Abstract

Introduction: Intraosseous ganglion cysts are an uncommon variant found in the subchondral bone. We report here the development of an intraosseous ganglion cyst of the proximal tibia in the setting of a prior left total knee arthroplasty (TKA) with an all-polyethylene tibial component.

Case report: The cyst was diagnosed on routine follow-up radiographs approximately 4 years status post-TKA. Although initially asymptomatic, 1 year later the patient presented with progressive knee pain and ambulation limitations, so revision TKA was indicated. Computed tomography confirmed an osteolytic lesion suggestive of a penetrating ganglion. Given the absence of malrotation or malalignment of the well-fixed femoral component, the decision was made to proceed with tibial revision to stemmed component cemented through a porous tantalum cone. Postoperatively, the patient had complete resolution of pain and instability with 0-120° of stable range of motion, which has persisted to the latest follow-up at over 6 months post-operative, with radiographic resolution of the cyst.

Conclusion: This case demonstrates a ganglion cyst surrounding total knee implants as a possible source of persistent pain following TKA. To our knowledge, this is the first report of such a case. This case demonstrates that refractory painful knee implants secondary to tibial ganglion cysts can be treated successfully with revision arthroplasty.

Keywords: Knee revision arthroplasty; ganglion cyst; outcomes; porous cone.

Figure 1

Routine post-operative anterior-posterior (left) and lateral (right) radiographs status post-left total knee arthroplasty with an all-polyethylene tibial component without abnormality.

Figure 2

Anterior-posterior (left) and lateral (right) radiographs of the left knee obtained at follow-up demonstrating an expansile lesion in the medial aspect of the proximal tibia.

Figure 3

Axial view of computed tomography demonstrating 1.8×1.7×3.9 cm osteolytic lesion with surrounding sclerosis in proximal tibia.

Figure 4

Coronal view of computed tomography demonstrating 1.8×1.7×3.9 cm osteolytic lesion with surrounding sclerosis in proximal tibia.

Figure 5

Medium power H&E photomicrograph revealing a lumen surrounded by a dense fibrous connective tissue wall consistent with ganglion cyst.

Figure 6

Anterior-posterior (left) and lateral (right) radiographs of the left knee status post-revision total knee arthroplasty demonstrating stable fixation of the revision components with a resolution of the intraosseous cyst.