The present case was a 63-year old man undergoing treatment for liver cirrhosis and diabetes, who presented with a subjective symptom of mild left knee pain that first developed in 1978. The patient was diagnosed with rheumatoid arthritis upon examination by a local physician for swelling in the right wrist joint in 2001, and with steroids, gold, and anti-inflammatory analgesic drugs was administered.
As exacerbation of symptoms the patient first visited our clinic in June. As X-ray examination revealed giant geodes in the lateral and medial femoral condyles as well as in the tibial condyle, in addition to joint destruction and tibial plateau fracture, total knee arthroplasty (TKA) with a stem was performed for both the femur and tibia. Since the geodes showed massive bone defects, artificial bone was used concomitantly with resected autologous bone, and the implant was using bone cement fixated. The patient did not have any difficulty in walking at 4 months follow-up study.
TKA for the RA patients with geodes has been reported in a number of studies using resected bone in most cases. Grafts such as autologous iliac bone, artificial bone, and allogeneic bone in addition to resected bone, as well as cement filling may be necessary in cases of giant geodes. However, the factors such as age and activity level of the patient and early fixation of the artificial joint should be considered for the treatment in cases of giant geodes.
