Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. May 18, 2022; 13(5): 538-543
Published online May 18, 2022. doi: 10.5312/wjo.v13.i5.538
Extensive adhesion formation in a total knee replacement in the setting of a gastrointestinal stromal tumor: A case report
Steven Mitchell, Anderson Lee, Ryan Stenquist, David Yatsonsky II, Megan L Mooney, Vithal B Shendge
Steven Mitchell, Anderson Lee, Ryan Stenquist, David Yatsonsky II, Megan L Mooney, Vithal B Shendge, Department ofOrthopaedic Surgery, The University of Toledo Medical Center, Toledo, OH 43614, United States
Author contributions: Mitchell S, Lee A, Stenquist R, and Yatsonsky II D provided appreciable assistance with literature review, case reporting and management, and significant editing of the final manuscript; Mitchell S, Mooney M, and Shendge V participated in surgical appraisal of this case and were involved with orthopedic management of this case, as well as significant editing of the final manuscript.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors report no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Vithal B Shendge, MD, Academic Research, Assistant Professor, Surgeon, Department of Orthopaedic Surgery, The University of Toledo Medical Center, 3065 Arlington Avenue, Toledo, OH 43614, United States. vithal.shendge@utoledo.edu
Received: December 12, 2021
Peer-review started: December 12, 2021
First decision: January 22, 2022
Revised: February 4, 2022
Accepted: April 24, 2022
Article in press: April 24, 2022
Published online: May 18, 2022
Processing time: 151 Days and 7.3 Hours
Abstract
BACKGROUND

Gastrointestinal stromal tumors (GISTs) are rare primary neoplasms of the gastrointestinal tract, accounting for 1% to 2% of all gastrointestinal neoplasms worldwide. GISTs are frequently discovered incidentally during workup for other diagnosis or intestinal obstruction, as they can present with few or no symptoms. Simultaneously, GISTs confer a high degree of malignant transformation, with a progression in about 10% to 30% of cases.

CASE SUMMARY

A 63-year-old healthy female presented to our institution with complaints of right knee pain and limited passive and active motion in the setting of a previous right total knee arthroplasty (TKA). One year after TKA, the patient was incidentally diagnosed with a GIST, which was successfully removed. After removal, the patient continued to have limited range of motion of the right knee and subsequently underwent revision TKA. Intraoperatively significant fibrotic adhesions were found encapsulating the femoral and tibial components. The patient’s pain improved postoperatively, however, she continued to have decreased range of motion with difficulty ambulating.

CONCLUSION

We propose that this case may demonstrate a proinflammatory milieu arising from a GIST, which had a direct influence on the outcome of recent total knee arthroplasty. This proposed mechanism between neoplastic cytokinetic activity and adhesion formation could have implications on preoperative and postoperative orthopedic management of total knee arthroplasty.

Keywords: Gastrointestinal stromal tumor; Adhesion formation; Total knee arthroplasty; Inflammatory response; Decreased range of motion; Case report

Core Tip: This case demonstrated a patient who had recurrent adhesion formation resulting in reduced clinical outcomes, hypothesized to be secondary to a gastrointestinal stromal tumor (GIST) inflammatory response. Currently, there is a paucity of literature documenting GIST tumors and potential adhesion formation and decreased clinical outcomes in patients with prosthetic joints.