Abstract
A 67-year-old male with a past medical history of coronary artery disease, hypertension, and obesity presented with severe left knee pain and severe tricompartmental osteoarthritis. After failing conservative treatments and completing a preoperative medical workup, the patient was scheduled for total knee arthroplasty. Intraoperatively, a pathologic fracture of the distal femur was discovered, and the procedure was aborted. Histopathologic evaluation of the femur fracture revealed diffuse large B-cell lymphoma. Intraoperative discovery of a pathologic fracture should be treated as an underlying malignancy until proven otherwise. In these cases, surgery should be aborted until definitive diagnosis and management can be planned.