32 hours ago We report a case of total knee arthroplasty (TKA) failure presenting initially as a large popliteal cyst without bony destruction in a 66-year-old woman. A foreign body gigantocellular inflammatory reaction against polyethylene wear particles was found on histology. The size of the cyst and the absence of bony destruction can be due to an exclusive early intramuscular granulomatous reaction. >> Go To The Portal
Abstract We report a case of total knee arthroplasty (TKA) failure presenting initially as a large popliteal cyst
A fluid-filled cyst formed at the back of the knee.
Full Answer
The result is a Baker's, or popliteal, cyst. Although these cysts usually are not dangerous, they may be accompanied by uncomfortable symptoms, including swelling, pain and stiffness in the knee. As in your situation, the typical first step in treating a Baker's cyst is draining the fluid from it.
Treatment of popliteus injuries
What is a popliteal cyst? A popliteal cyst, also known as a Baker’s cyst, is a fluid-filled swelling that causes a lump at the back of the knee, leading to tightness and restricted movement. The cyst can be painful when you bend or extend your knee.
Though popliteal cysts are an infrequently reported complication of a knee arthroplasty, it is evident that patients develop popliteal cysts at an appreciable rate following knee arthroplasty.
A Baker's cyst, also called a popliteal (pop-luh-TEE-ul) cyst, is usually the result of a problem with your knee joint, such as arthritis or a cartilage tear. Both conditions can cause your knee to produce too much fluid, which can lead to a Baker's cyst.
A Baker's cyst, also called a popliteal cyst, is a fluid-filled swelling that develops at the back of the knee. Credit: It's caused when the tissue behind the knee joint becomes swollen and inflamed.
Most Baker cysts go away without surgery. Healthcare providers only rarely advise surgery. You might need surgery if your Baker cyst is causing you severe symptoms and no other treatments have worked. Your provider will check you carefully for other knee problems to treat before advising surgery.
TreatmentMedication. Your doctor may inject a corticosteroid medication, such as cortisone, into your knee to reduce inflammation. ... Fluid drainage. Your doctor may drain the fluid from the knee joint using a needle. ... Physical therapy. Icing, a compression wrap and crutches may help reduce pain and swelling.
Baker's cysts aren't dangerous and they may go away on their own. But occasionally they burst, and if that happens, synovial fluid can leak into the calf below, causing pain, swelling, and reddening.
There are two types of treatment for popliteal cysts: surgical and nonsurgical. Whether or not the cyst has ruptured, how painful the cyst has become, or how much it interferes with the normal use of your knee will determine which is the best course of treatment for you.
When to see the doctor for a Baker's cyst. Swelling that comes on quickly or doesn't go away may be a sign of infection. Other signs of infection include fever, tiredness, and severe knee pain. You should also call your doctor if you experience shortness of breath along with swelling in your leg.
Sometimes you'll feel no pain at all, or only a slight pain with a Baker's cyst. You may only have knee pain from the initial damage that caused the Baker's cyst, but not the lump itself. Any strain can cause this lump or your knee to swell in size.
The most important way to treat a Baker's cyst is to effectively treat the underlying cause of knee swelling. When a Baker's cyst doesn't go away on its own, an orthopedic specialist may use a needle and syringe to drain the cyst and/or use a corticosteroid injection to decrease pain, inflammation, and swelling.
It typically takes around four weeks after baker's cyst excision for the wound to completely heal. A firm bump of scar tissue will form in the incision. As the wound heals, the bump will slowly go away. Stitches are usually removed about two weeks after surgery.
Baker cyst may cause lower limb ischemia through obstruction of arterial flow, requiring surgical intervention. Fluid-filled Baker cysts are the most common masses found around the knee joint.
Can a Baker's cyst be prevented?Wearing proper footwear.Using the balls of your feet to turn instead of your knees.Warming up properly before you exercise and cooling down afterward.Stopping immediately when you get a knee injury.
When to see the doctor for a Baker's cyst. Swelling that comes on quickly or doesn't go away may be a sign of infection. Other signs of infection include fever, tiredness, and severe knee pain. You should also call your doctor if you experience shortness of breath along with swelling in your leg.
RemediesApply ice or cold packs to the cyst to reduce pain and swelling.Apply heat to the area. ... Take nonsteroidal anti-inflammatory drugs such as acetaminophen or ibuprofen.Avoid any activities that cause pain. ... Gently massage the area around the cyst to ease any pain and help reduce inflammation.
Why exercise helps treat and decrease the symptoms of a Baker's cyst. Regular, gentle exercises can increase your range of motion and strengthen the muscles around your knees. By exercising several times per week, you can decrease some of the symptoms you may be experiencing as a result of this fluid-filled sac.
Popliteal cysts are an infrequently reported complication of primary knee arthroplasty. In our series, they occur rarely in 0.6% of knee arthroplasties and generally become symptomatic and evident during the first post-operative year. Several treatment strategies for symptomatic popliteal cysts in the native knee have previously been proposed. Conservative management is often the first strategy attempted, followed by aspiration and/or injection, with or without ultrasound13,14. Surgical treatment options include correction of the intra articular knee pathology15, closure of the communication between the cyst and the articular cavity to eliminate flow of synovial fluid16, expansion of the communication between the cyst and cavity to eliminate unidirectional flow of synovial fluid2,16-19. and removal of the cyst wall20,21. Existing literature discussing treatment of popliteal cysts that result following a total knee arthroplasties is limited to case reports. In two studies, dissecting popliteal cysts were reported as the presenting symptom of a malfunctioning total knee arthroplasty. In this series, the cysts resolved with revision of the TKA and did not require further treatment6,10.
An additional seven Baker’s cysts were detected pre-operatively, all of which resolved or remained asymptomatic following primary knee arthroplasty.
Popliteal cysts, when asymptomatic, are usually found incidentally. However, they have the potential to become symptomatic, appearing as palpable swellings in the posterior knee that may mimic other pathologies. While there exists a substantial body of literature concerning popliteal cysts in the native knee, discussion of popliteal cysts following knee arthroplasty is limited to a few case reports3-10. Though popliteal cysts are an infrequently reported complication of a knee arthroplasty, it is evident that patients develop popliteal cysts at an appreciable rate following knee arthroplasty. Popliteal cysts that occur following knee arthroplasty should not be confused with preexistent popliteal cysts that fail to resolve following knee arthroplasty, which remain symptomatic in 31% of patients and resolve only 15% of the time11. Among other causes of knee pain in the setting of knee arthroplasty, rupture or enlargement of a popliteal cyst can lead to acute calf pain and tightness, tenderness, or erythema10. Rarely, peripheral nerve symptoms can occur as a result of tibial nerve compression12. Several treatment methods for popliteal cysts in the setting of knee arthroplasty are described, including percutaneous aspiration and/ or injection, arthroplasty revision, as well as a two-stage operation including arthroplasty revision followed by complete resection of the cyst.
The literature regarding popliteal cysts occurring following knee arthroplasty is limited and does not report prevalence, natural history, and treatment of popliteal cyst in the setting of knee arthroplasty.
Current procedural terminology codes were used to locate charts with popliteal cysts. Additionally, it is possible that not all asymptomatic popliteal cysts were detected on exam. The investigation is limited by its small number of patients treated. Finally, it is possible that some of our reported popliteal cysts were simply never noticed pre-operatively and did not in fact occur initially in the post-operative knee.
There are 4 moments of TKA surgical procedure during which vessels, especially popliteal artery can be damaged: 1) at the tibial cut, 2) at the posterior cut of the femoral condyles, 3) during the application of retractor for anterior dislocation of the tibia, and 4) during placement of the knee in hyperextension after the cuts and before the application of the hardware [26], [31]. We presented two cases of sharp damage of popliteal artery during TKA. In the first case, popliteal artery semi-transected during tibial cut, while in the second case the artery was damaged by retractors placement during anterior dislocation of the tibia. The time of diagnosis of these complications was similar to other studies of the published literature. Popliteal semi-transection was diagnosed on the day of surgery, but pseudoaneurysm was diagnosed on the 40th postoperative day. This delay was due to misdiagnosis as deep vein thrombosis. Early diagnosis is essential since delayed diagnosis has been showed to be associated with a higher risk for amputations [32]. Prompt diagnosis depends on two things: clinical awareness of these complications and careful Doppler assessment. Clinical awareness includes assessment for signs of vascular insufficiency such as pallor, poor capillary refill and disturbed neurological status [33]. In our study, both cases were treated eventually by open surgical means, though in one case endovascular thrombectomy was initially performed without successful results.
Vascular complications during total knee arthroplasty (TKA) are rare. Their incidence ranges from 0.003% to 0.23% [1], [2], [3], [4], [5], [6], [7], [8]. The importance of early diagnosis and management of these devastating complications is obvious, since mortality and amputation is 7% and 42%, respectively [9]. Previous conditions related to an increased risk of vascular complications include peripheral vascular disease, especially in patients with stent deployment, weight loss, renal failure, coagulopathy and metastatic cancer [1], [10]. The majority of vascular injury during TKA involves the popliteal artery. There are few studies describing injury to the geniculate arteries during TKA [11], [12]. Based on the anatomical damage and cause, vascular injuries can be classified as follows: 1) Occlusion. The cause of occlusion may be: i) Thrombosis due to vascular wall damage. Low blood flow as a result of tourniquet application is an additional factor for thrombosis. The damage can be caused by microtears, endothelial damage and stretching of the vessels during manipulations of the knee. The application of the tourniquet or the thermal injury by the cement may also lead to thrombosis. A rare cause of arterial occlusion is compression of the popliteal artery by the knee implant [13], ii) Embolization by calcified plates from another site, usually from the area where the tourniquet has been applied; 2) Popliteal artery sharp transection during the cuts; 3) Arteriovenous (A-V) fistula formation; 4) Aneurysm or more commonly pseudoaneurysm formation. The mechanism of pseudoaneurysm formation may be direct, as a result of a partial tear on the arterial wall, or indirect due to mechanical stretching or thermal injury from the cement [14], [15], [16]. Often, pseudoaneurysm can be misdiagnosed as deep vein thrombosis [7], [17], [18].
Vascular complications can be managed by open or endovascular means. Endovascular methods include: 1) Thrombectomy with a Fogarty catheter; 2) Angioplasty, usually with covered stents or balloon in cases of arterial tear and occlusion; 3) Coil embolization in case of pseudoaneurysm; 4) Pharmacomechanical thrombolysis. Open methods include: 1) Open thrombectomy; 2) Direct repair of the vessel (a vein or synthetic patch can be used) or excision of the damaged part followed by end-to-end anastomosis, in case of arterial tear or pseudoaneurysm; 3) Deployment of artery bypass or interposition graft 4) Above the knee amputation. Additionally, there are percutaneous methods of treatment, such as thrombin injection into the pseudoaneurysm. Staged treatment which include as a first step endovascular management has less morbidity and good results. The only absolute indication for open repair is active hemorrhage [19]. Patients after endovascular treatment need a long-term follow-up using Doppler assessment in order to identify any recurrent stenosis of the injured artery [20]. In this study we present two rare cases of vascular complications during TKA. Two patients presenting with popliteal pseudoaneurysm and popliteal tear, respectively, are reported.
Preoperatively, clinical examination for detection of atherosclerotic disease or any other vascular problems is recommended, and patients with positive signs such as trophic changes of skin or venous guttering should be referred to a vascular surgeon [34]. Intraoperatively, great attention must be paid during the four mentioned moments of the procedure. Postoperatively, clinical awareness and careful Doppler examination are the keys to an early diagnosis of arterial injury.
Injury of popliteal artery during total knee arthroplasty is a relatively rare complication. We report on one case of transverse semi-dissection of the popliteal artery during the tibial cut and one case of popliteal pseudoaneurysm formation caused by Hohmann retractors. Diagnosis was made early in the first case but it was delayed in the second due to misdiagnosis of deep vein thrombosis. Both injuries were managed eventually by open surgery. Postoperative clinical examination and ultrasound imaging confirmed the successful restoration of the blood flow. This case report also describes the classification system of the type of vascular damage and describes the mechanism, the clinical presentation, diagnostic modalities and treatment options for these rare complications of total knee arthroplasty surgery.
A potential risk factor of total knee arthroplasty: an infected Baker's cyst - a case report
Baker's cysts are not usually subject to extensive preoperative evaluation because the cysts often disappear naturally after surgery, unaccompanied by any adverse symptoms. Case presentation: A 63-year-old woman presented with moderate pain in the left knee joint that had developed 1 year ago.
A Baker's cyst that was aspirated and still causes symptoms with altered blood tests needs to be evaluat ed accurate ly before TKA.