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.

Saul Hernandez Rodriguez earned his medical degree at the University of Puerto Rico Medical Science Campus and completed his orthopedics residency. He completed his fellowship training in Adult Reconstruction surgery at the Miller School of Medicine in Miami.