An Unusual Cause of Late Pain and Effusion After Total Knee Arthroplasty: Pulmonary Hypertrophic Osteoarthropathy
A Case Report
James Meeker, MD; Paul F. Lachiewicz, MD

The common causes of pain and effusion after total knee arthroplasty are infection, instability, loosening, and patellofemoral problems. Fehring et al. reported that the primary cause of failure in a series of 440 revision knee arthroplasties was infection and 63% of the revisions failed within five years after the operation1. In a review of 212 revision total knee arthroplasties performed at one center, Sharkey et al. reported that the three most common reasons for failure were polyethylene wear, aseptic loosening, and instability2.

A carefully recorded history and physical examination can often identify the cause of pain and effusion, especially in patients with instability. Routine radiographs can be used to evaluate the knee alignment and fixation status of the components. Laboratory studies, such as the erythrocyte sedimentation rate and C-reactive protein level, may be helpful in screening for infection3,4. Aspiration at the site of the prosthetic knee joint has been considered the single most helpful test in determining the presence of an early or late metastatic infection4,5. There have also been reports of acute crystalline-related synovitis at the sites of knee arthroplasties6,7.

We report an unusual cause of late pain and effusion due to hypertrophic pulmonary osteoarthropathy in a patient who had had a bilateral total knee arthroplasty. The patient was informed that data concerning the case would be submitted for publication and consented.

Case Report

A seventy-seven-year-old woman presented in early February 2007 with a two-month history of pain and swelling in both knees. She had undergone …

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