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Albert W. Pearsall, IV, MD, William
C. Mayfield, III, MD, University of South Alabama Medical
Center
Popliteal cysts are commonly
associated with intraarticular knee pathology including degenerative
meniscal tears, pigmented villonodular synovitis, and inflammatory
diseases. A dissecting popliteal cyst after total knee arthroplasty
is a rare complication, with few reports in the literature.
Indeed, the majority of such cysts are stable and frequently
do not require excision.
The clinical presentation of
a popliteal cyst can be quite similar to that of thrombophlebitis.
If ruptured, such cysts have been reported to simulate a deep
vein thrombosis with false radiofibrinogen uptake.
We report the case of a 63-year
old woman who underwent a right total knee arthroplasty at
an outside institution 10 years prior to presentation at our
clinic. She presented with a symptomatic popliteal cyst of
several months' duration. Her cyst was excised, and she experienced
complete pain relief. At the time of surgery, communication
with the knee joint was noted. Gross pathology revealed a
multiloculated cyst with a well-defined, thickened wall. Aspirated
cyst fluid revealed polyethylene debris. Polarized light microscopic
examination revealed refractile extracellular polyethylene
particles.
Three months later, repeat radiographs
were taken, revealing continued polyethylene wear. Despite
her lack of clinical symptoms and her improvement after cyst
removal, she was returned to the operating room and underwent
uneventful polyethylene exchange. At latest follow-up (6 months),
she is pain-free and has a stable knee with no recurrence
of the cyst.
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