{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T22:38:35Z","timestamp":1773787115689,"version":"3.50.1"},"reference-count":18,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,4,24]],"date-time":"2025-04-24T00:00:00Z","timestamp":1745452800000},"content-version":"vor","delay-in-days":113,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T00:00:00Z","timestamp":1735689600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Case Reports in Orthopedics"],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:p>Herein, we present a rare case of periprosthetic joint infection (PJI) which was triggered by an infection with a latent subcutaneous cyst on the thigh and occurred in a strange course following total knee arthroplasty (TKA). An 87\u2010year\u2010old female underwent right TKA followed by left TKA 5\u2009months later. Six weeks after left TKA, a painful subcutaneous induration appeared in the left medial thigh. Magnetic resonance imaging revealed a 30\u221750\u2010mm multifocal mass. The cystic fluid was brown and cloudy, indicating an infected cyst. Oral antimicrobial therapy was initiated for 7\u2009days. Nine weeks after the left TKA, a left calcaneal fracture occurred. Subsequently, edema of the lower extremities and pain in the left knee gradually developed. Arthrocentesis was performed twice: joint fluid Gram staining and culture examination were negative. However, at 12.5\u2009weeks, an alpha\u2010defensin test of the synovial fluid was positive. Therefore, PJI was diagnosed. DAIR was performed, followed by multiantibiotic therapy. The infection subsided gradually. Edema of the lower limbs was treated with oral diuretics, lymphatic massage, and compression stockings. Consequently, the lower limb edema also improved. In this case, infection of a latent subcutaneous cyst in the thigh occurred and spread around the prosthesis due to leg edema, which was associated with loss of lower limb motion due to a calcaneal fracture. The presence of a potential thigh subcutaneous cyst is a risk factor for PJI. Moreover, lower extremity edema occurs by decreasing lower extremity motion, such as after a calcaneal fracture, and it increases the risk of extending extra\u2010articular infection to the PJI. Potential thigh subcutaneous cysts and lower extremity edema are risk factors for the development of PJI. Orthopedic surgeons need to be aware of these facts during follow\u2010up after TKA.<\/jats:p>","DOI":"10.1155\/cro\/7710384","type":"journal-article","created":{"date-parts":[[2025,4,24]],"date-time":"2025-04-24T07:34:04Z","timestamp":1745480044000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Periprosthetic Joint Infection Occurring Following a Femoral Subcutaneous Cyst: A Rare Complication Post\u2013Total Knee Arthroplasty"],"prefix":"10.1155","volume":"2025","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-3186-0390","authenticated-orcid":false,"given":"Naohiro","family":"Oka","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shigeshi","family":"Mori","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yu","family":"Shinyashiki","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nobuhisa","family":"Shokaku","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenji","family":"Yamazaki","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Koji","family":"Goto","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daisuke","family":"Togawa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,4,24]]},"reference":[{"key":"e_1_2_9_1_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)32344-4"},{"key":"e_1_2_9_2_2","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.99B5.BJJ-2016-0562.R2"},{"key":"e_1_2_9_3_2","doi-asserted-by":"publisher","DOI":"10.1002\/jor.24293"},{"key":"e_1_2_9_4_2","first-page":"17","article-title":"Evolution of TKA Design","volume":"88","author":"Dall\u2032Oca C.","year":"2017","journal-title":"Acta Bio Medica: Atenei Parmensis"},{"key":"e_1_2_9_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2022.10.035"},{"key":"e_1_2_9_6_2","doi-asserted-by":"publisher","DOI":"10.1302\/2058-5241.1.000032"},{"key":"e_1_2_9_7_2","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.2021204146"},{"key":"e_1_2_9_8_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra040181"},{"key":"e_1_2_9_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejrad.2005.12.039"},{"key":"e_1_2_9_10_2","doi-asserted-by":"publisher","DOI":"10.3389\/fcimb.2023.1129072"},{"key":"e_1_2_9_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2016.01.006"},{"key":"e_1_2_9_12_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.TA.0000064463.46924.9D"},{"key":"e_1_2_9_13_2","first-page":"44","article-title":"Leg Edema Assessment and Management","volume":"23","author":"Simon E. 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