Implant-Associated Diffuse Large B-Cell Lymphoma following Total Knee Replacement Arthroplasty: Case Report of a Non-EBV-Related Case with Review of Literature

Abstract Implant-related sarcomas are infrequent but well-known complications following joint replacement surgery. Periprosthetic lymphomas are still rarer and difficult to diagnose as they can clinically mimic aseptic loosening or joint infection. A 68-year-old female who underwent knee replacement surgery 2 years earlier presented with pain in the left knee and thigh. Imaging findings were suggestive of prosthesis-related sarcoma. CT-guided biopsy revealed diffuse large B-cell lymphoma and Epstein − Barr virus-encoded RNA testing by in situ hybridization was negative. The patient received five cycles of chemotherapy, and post-therapy her radiographs showed complete resolution of the extraosseous soft tissue component in the suprapatellar recess and posterior aspect of the femur. Whole body PET-CT also showed complete resolution of metabolically active lesion in the left distal femur. Most metallic-implant-associated lymphomas are associated with Epstein − Barr virus infection. Non-Epstein-Barr virus-related lymphomas are rarer, and a high index of suspicion should be kept in mind in cases of prosthetic failure.