Stress-Induced, Aseptic Osteolysis of the Mid-Tibia in a Revision Hinged Total Knee Arthroplasty Mimicking Infection

In this report, we present the case of an 80-year-old female with pain located over the tip of her cemented tibial stem in a revision hinge total knee arthroplasty with localized osteolysis that looked suspicious for infection. A thorough workup was negative for infection. We postulate that the osteolysis at the end of her tibial stem was initiated by a modulus of elasticity mismatch at the stem tip, which generated a focal area of increased sagittal bone bending and microparticle generation. She was treated with lesional exploration, debridement, synthetic bone grafting, and tibial plating to distribute stress loads away from the tibial stem tip. Histologic analysis identified no organisms or neoplasm. Her pain ultimately resolved, and the patient returned to her customary activities.