Disclosures: Graham P. McRary, MD: No financial relationships or conflicts of interest

Case Description: The patient underwent left TKA for severe degenerative joint disease four months prior to presentation. Since his operation, he suffered from persistent pain in his medial proximal tibia that radiated down the anterolateral calf. Postoperative x-ray was unremarkable. Prior to his office visit, he had received treatment for pes anserine bursitis, including corticosteroid injection, cold laser therapy, and oral medications without relief. On examination, he was tender to palpation directly over the pes anserine insertion site. Ultrasound evaluation revealed a solid body protruding into the gracilis, sartorius, and semitendinosus tendon complex. He underwent CT scan, which showed lucency around the tibial stem and left tibial component, concerning for hardware loosening. He was evaluated by orthopedics, who performed a TKA revision. Surgery was unfortunately complicated by an intra-operative anteromedial tibia fracture that required K-wire fixation. Postoperative rehabilitation was prolonged due to the need for 6 weeks of 50% weight bearing for fracture healing.

Setting: Outpatient clinic.

Patient: A 61-year-old male status-post total knee arthroplasty (TKA) with pain in the proximal tibia. Assessment/

Results: At 10-weeks post-TKA revision, the patient had complete resolution of his pes anserine pain.

Discussion: This is the first reported case, to our knowledge, of TKA prosthetic loosening presenting with pes anserine pain initially identified on ultrasound evaluation.

Conclusion: In patients with a history of TKA, ultrasound can provide useful diagnostic information for further characterization and evaluation of atypical causes of common complaints.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/ultrasound-evaluation-of-pes-anserine-pain-revealing-total-knee-arthoplasty-prosthetic-loosening-a-case-report/