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Angiosarcoma after revision total knee arthroplasty
Affiliation:1. Department of Orthopedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan;2. Department of Orthopedic Surgery, Teine Keijinkai Hospital, Teine-Ku, Sapporo, Hokkaido, Japan;3. Department of Functional Reconstruction for the Knee Joint, Hokkaido University, Sapporo, Hokkaido, Japan;4. Department of Orthopaedic Surgery, Eniwa Hospital, Eniwa-Shi, Hokkaido, Japan;5. Department of Musculoskeletal Oncology, Hokkaido Cancer Center, Shiroishi-Ku, Sapporo, Hokkaido, Japan;6. Department of Surgical Pathology, Hokkaido University Hospital, Sapporo, Hokkaido, Japan;7. Centre for Sports Medicine, Hokkaido University Hospital, Sapporo, Hokkaido, Japan;1. Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, 51 49 Little France Crescent, Old Dalkeith Road, Edinburgh EH16 4SA, United Kingdom;2. Department of Orthopaedics, The University of Edinburgh, 49 Little France Crescent, Old Dalkeith Road, Edinburgh EH16 4SA, United Kingdom;1. South West London Elective Orthopaedic Centre, Dorking Road, Epsom, Surrey KT18 7EG, United Kingdom;2. The Robert Jones and Agnes Hunt Orthopaedic Hospital, Gobowen, Oswestry SY10 7AG, United Kingdom;3. The Royal London Hospital, Whitechapel, London E1 1BB, United Kingdom;1. Department of Orthopaedic Surgery, Yokohama City University School of Medicine, Yokohama, Japan;2. Department of Orthopaedic Surgery, International University of Health and Welfare Atami Hospital, Atami, Japan
Abstract:BackgroundHemarthrosis after total knee arthroplasty (TKA) is a relatively rare complication. Although most cases are effectively treated with conservative therapy, some cases require angiographic embolization or surgical intervention. Angiosarcoma is a rare malignant tumor derived from the vascular endothelium with neovascular hyperplasia and mainly arises in the skin and superficial soft tissue, and less frequently in deep soft tissue and bone. Although malignant neoplasms such as angiosarcoma in the vicinity of orthopedic implants were reported, the causal relationship between development of the malignant tumor and the orthopedic implant is widely debated in the literature.Case presentationWe report the case of a 68-year-old female with angiosarcoma that developed in the knee joint 2 years after revision TKA. The patient exhibited severe persistent bleeding, which reached 1000–1400 ml per day for 4 months. Histological analysis of the synovial tissue in the knee joint showed large cells with nuclear atypia. Immunohistochemical staining showed cells that were positive for CD31, CD34, and D2-40, and she was diagnosed with angiosarcoma. The patient underwent an amputation at the level of the thigh, and her general condition immediately improved after the operation. The patient did not exhibit bleeding from the site of amputation, and no local recurrence or distant metastases were detected 1 year after the amputation.ConclusionsTo the best of our knowledge, this represents the first report of angiosarcoma 2 years after revision TKA. Further careful follow up is needed, given the high-grade malignancy.
Keywords:Angiosarcoma  Above-the-knee amputation  Total knee arthroplasty  Hemarthrosis  Case report
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