case_images: PMC10546056_01
case_images: (A) Pelvic radiograph (anteroposterior view) showing an excessive femoral neck-stem angle and fusion of the right femoral head and pelvis. Extensive hyperosteogeny of the right femoral head is observed. (B,C) Lumbar radiographs (anteroposterior and lateral views) showing multilevel narrowing of the thoracic and lumbar intervertebral spaces and lumbar spondylolisthesis, with osteophytosis, calcification, and subchondral osteosclerosis. (D) Radiograph of the knee (anteroposterior view) showing severe degeneration, extensive osteophytosis, significant joint space narrowing, and subcortical osteosclerosis. (E,F) Preoperative radiographs of the bilateral knees (lateral views) showing narrowed joint spaces, loose bodies, severe subchondral osteosclerosis, and extensive osteophytosis.
case_images: fmed-10-1212580-g001.jpg
case_images: PMC10546056_01_fmed-10-1212580-g001.jpg
case_images: F1
case_images: Imaging revealed an excessive femoral neck-stem angle, right hip ankylosis, and extensive hyperosteogeny of the right femoral head (Figure 1A). Spinal radiography showed multilevel narrowing of the thoracic and lumbar intervertebral spaces and lumbar spondylolisthesis with osteophytosis, calcification, and subchondral osteosclerosis (Figures 1B, C). We detected no radiographic abnormalities of the sacroiliac joints or osteoporosis (Figures 1D-F).
case_images: (A,B) Intraoperative images showing severe destruction of the femoral head cartilage and darkened subchondral bone. (C) Naked-eye examination of urine showing normal appearance of the urine immediately after sample collection. (D) Image obtained after exposure of urine to air for 24 h showing darkening of urine color. (E) Intraoperative images showing darkening of the soft tissue to a brown and black color. (F) Image showing pigmentation on the articular surface of the femur. (G) Image showing pigmentation on the articular surface of the patella. (H) Image obtained after prosthesis placement.
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case_images: PMC10546056_01_fmed-10-1212580-g002.jpg
case_images: F2
case_images: The color of fresh urine did not differ from that of urine obtained from healthy individuals; however, urine samples that were allowed to stand appeared chocolate-brown 24 h later (Figures 2C, D). Removal of superficial tissues revealed dark spots on the gluteus medius, gluteus minimus, and the hip joint capsule appeared brown (Figure 2E). In the weight-bearing area, the cartilage was worn out and rough and appeared black, and normal-colored subchondral bone was exposed (Figures 2A, B). Similar to intraoperative findings during THA, we observed cartilage and synovial pigmentation (Figures 2F-H).
case_images: (A) Bedside hip radiograph (anteroposterior view) obtained the day following surgery showing anteversion and abduction angles within the normal range based on the Lewinnek and Callanan safe zones. (B,C) Radiographs of the knee (anteroposterior and lateral views) obtained the day following TKA showing correct prosthesis placement. TKA, total knee arthroplasty.
case_images: fmed-10-1212580-g003.jpg
case_images: PMC10546056_01_fmed-10-1212580-g003.jpg
case_images: F3
case_images: Plain pelvic radiographs showed correct positioning and size of the prosthesis, with accurate measurements of the anteversion and abduction angles (Figure 3A). Plain radiographs of the knee obtained the day following surgery showed correct positioning of the prosthesis (Figures 3B, C).
case_images: (A) Graph showing the HHS, FJS (hip) and VAS scores obtained preoperatively and at the 1-, 3-, 6-, 9-, 11-, and 14-month follow-ups. (B) Graph showing the KSS, FJS (knee), and VAS scores obtained preoperatively and at the 1-, 3-, and 6-month follow-ups. FJS, forgotten joint score; HHS, Harris hip score; KSS, Knee Society Score; VAS, visual analog score.
case_images: fmed-10-1212580-g004.jpg
case_images: PMC10546056_01_fmed-10-1212580-g004.jpg
case_images: F4
case_images: The HHS score was 26 preoperatively and 45, 68, 76, 90, 92, and 94 at 1, 3, 6, 9, 11, and 14 months, respectively, after the THA. The FJS (hip) was 27.8, 52.8, 81.1, 89.0, 90.6, and 92.4 at 1, 3, 6, 9, 11, and 14 months, respectively, after the THA (Figure 4A). The KSS was 36 preoperatively, 74 at the 1-month, 82 at the 3-month, and 90 at the 6-month follow-up, respectively. The FJS (knee) was 36.6, 63.9, and 84.5 at the 1-, 3- and 6-month follow-ups, respectively (Figure 4B).