Synovial fistula of the knee occurs when there is a defect in the joint capsule, creating a connection between skin, bursa, or a near tissue, manifesting as an opening with continuous draining fluid or as a cyst. This is a case of an 80-year-old-male who developed a synovial fistula with cystic presentation 6 years after primary total knee arthroplasty (TKA). Management included a TKA revision surgery with intraoperative identification of the fistula with methylene blue and using a gelatin-thrombin matrix for closure. This case shows a possible complication of catastrophic polyethylene insert wear and management.

Liannette K Padilla Martinez completed a medical degree (MD) at the Universidad Autónoma de Guadalajara. Worked in orthopedics as a physician assistant with Dr Saul Hernández. She is undergoing medical training as a second-year resident in Internal Medicine at The Brooklyn Hospital Center.