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Liu Y, Li C, Zhang Z, Lu X, Zhang H. Ochronotic arthropathy effectively treated with total hip and total knee arthroplasty: a case report. Front Med (Lausanne) 2023; 10:1212580. [PMID: 37795417 PMCID: PMC10546056 DOI: 10.3389/fmed.2023.1212580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 09/06/2023] [Indexed: 10/06/2023] Open
Abstract
Ochronosis is a rare autosomal recessive disorder of tyrosine metabolism characterized by multilevel spinal degeneration and arthritis of large weight-bearing joints, which is referred to as ochronotic arthropathy. In this case report, we describe diagnosis and treatment of ochronotic arthropathy in a patient who underwent total hip arthroplasty (THA) and total knee arthroplasty (TKA). The Harris hip score was 26 preoperatively and 45, 68, 76, 90, 92, and 94 at 1, 3, 6, 9, 11, and 14 months, respectively, postoperatively. The forgotten joint score (FJS) of the hip was 27.8, 52.8, 81.1, 89.0, 90.6, and 92.4 at 1, 3, 6, 9, 11, and 14 months, respectively, postoperatively. TKA was performed 8 months after THA. The Knee Society Score was 36 before TKA and 74, 82, and 90 at 1, 3, and 6 months, respectively, after TKA. The FJS of the knee was 36.6, 63.9, and 84.5 at 1, 3, and 6 months, respectively, after TKA. The patient's knee range of motion returned to normal, with significant reduction in pain and improved satisfaction levels after TKA. THA and TKA can achieve good clinical outcomes in patients with ochronosis accompanied by severe joint pain.
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Affiliation(s)
- Yikai Liu
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Chenkai Li
- Department of Orthopedics, Peking Union Medical College, Beijing, China
| | - Zian Zhang
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xinzhe Lu
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Haining Zhang
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
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Firoozabadi MA, Mortazavi SMJ, Toofan H, Khalili M, Shariyate MJ. Black discoloration of the knee articular cartilage in a patient with pigmented villonodular synovitis: A case report. Clin Case Rep 2023; 11:e7894. [PMID: 37705584 PMCID: PMC10495615 DOI: 10.1002/ccr3.7894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 07/11/2023] [Accepted: 07/25/2023] [Indexed: 09/15/2023] Open
Abstract
In this case report, total knee arthroplasty was performed in a patient with pigmented villonodular synovitis. During surgery, severe black discoloration of the articular cartilage and menisci was observed in the patient. According to literatures, this is the first case report of severe articular cartilage pigmentation in a patient with pigmented villonodular synovitis.
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Affiliation(s)
- Mohammad Ayati Firoozabadi
- Tehran University of Medical Sciences(TUMS), Hip and Knee arthroplasty, Joint Reconstruction Research Center, Imam Khomeini HospitalTehran University of Medical SciencesTehranIran
| | - S. M. Javad Mortazavi
- Tehran University of Medical Sciences(TUMS), Hip and Knee arthroplasty, Joint Reconstruction Research Center, Imam Khomeini HospitalTehran University of Medical SciencesTehranIran
| | - Hesam Toofan
- Hip and Knee arthroplasty Joint Reconstruction Research Center, Imam Khomeini HospitalTehran University of Medical SciencesTehranIran
| | - Marzieh Khalili
- Hamadan University of Medical SciencesHamedan university of Medical ScienceHamedanIran
| | - Mohammad Javad Shariyate
- Department of Orthopaedic Surgery, Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMassachusettsUSA
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Alkaptonuria with asymmetric otologic involvement: a case report. Braz J Otorhinolaryngol 2021; 88 Suppl 1:S163-S165. [PMID: 33958308 PMCID: PMC9734251 DOI: 10.1016/j.bjorl.2021.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 03/19/2021] [Indexed: 12/29/2022] Open
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Sen Gupta PS, Islam RNUI, Banerjee S, Nayek A, Rana MK, Bandyopadhyay AK. Screening and molecular characterization of lethal mutations of human homogentisate 1, 2 dioxigenase. J Biomol Struct Dyn 2020; 39:1661-1671. [PMID: 32107984 DOI: 10.1080/07391102.2020.1736158] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- Parth Sarthi Sen Gupta
- Department of Biotechnology, The University of Burdwan, Bardhaman, West Bengal, India
- Department of Chemical Sciences, Indian Institute of Science Education and Research (IISER) Berhampur, Ganjam, Odisha, India
| | - Rifat Nawaz UI Islam
- Department of Biotechnology, The University of Burdwan, Bardhaman, West Bengal, India
| | - Sahini Banerjee
- Department of Biological Sciences, Indian Statistical Institute, Kolkata, West Bengal, India
| | - Arnab Nayek
- Department of Biotechnology, The University of Burdwan, Bardhaman, West Bengal, India
| | - Malay Kumar Rana
- Department of Chemical Sciences, Indian Institute of Science Education and Research (IISER) Berhampur, Ganjam, Odisha, India
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Stetson WB, Morgan SA, Hung NJ, Polinsky S. Knee Arthroscopy: A Diagnostic and Therapeutic Tool for Management of Ochronotic Arthropathy. Arthrosc Tech 2018; 7:e1097-e1101. [PMID: 30533354 PMCID: PMC6261060 DOI: 10.1016/j.eats.2018.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 07/10/2018] [Indexed: 02/03/2023] Open
Abstract
The surgical treatment of ochronotic arthropathy remains unclear. Although there is no absolute cure for ochronotic arthropathy, current management typically begins with conservative treatment. Total joint replacement may eventually be necessary for joints that become severely degenerative. Ochronotic arthropathy is present in patients with alkaptonuric ochronosis, which is characterized by dark pigmentation of connective tissue and black discoloration of urine owing to a deficiency of homogentisic acid oxidase. As a result, soft tissues become brittle and subsequently more susceptible to mechanical stress, resulting in articular cartilage degeneration. The diagnosis of ochronotic arthropathy of the knee often occurs intraoperatively after discovery of darkened synovium and black deposits during arthroscopy. The purpose of this article is to describe arthroscopic debridement as an effective treatment option and diagnostic tool for ochronotic arthropathy of the knee after failure of conservative measures.
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Affiliation(s)
- William B. Stetson
- Stetson Powell Orthopedics and Sports Medicine, Burbank, California, U.S.A.,Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, U.S.A.,Address correspondence to William B. Stetson, M.D., Stetson Powell Orthopedics and Sports Medicine, 191 S Buena Vista St, Ste 470, Burbank, CA 91505, U.S.A.
| | | | - Nicole J. Hung
- Stetson Powell Orthopedics and Sports Medicine, Burbank, California, U.S.A
| | - Samuel Polinsky
- Stetson Powell Orthopedics and Sports Medicine, Burbank, California, U.S.A
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Tanoğlu O, Arıcan G, Özmeriç A, Alemdaroğlu KB, Çaydere M. Calcaneal Avulsion of an Ochronotic Achilles Tendon: A Case Report. J Foot Ankle Surg 2018; 57:179-183. [PMID: 29113706 DOI: 10.1053/j.jfas.2017.07.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Indexed: 02/03/2023]
Abstract
Alkaptonuria is a hereditary disorder of phenylalanine and tyrosine, with an incidence of approximately 1/200,000 to 1/1,000,000. Ochronosis is the accumulation of homogentisic acid and its metabolites in connective tissues such as the tendons, cartilage, and skin. In the present case study, a 50-year-old male presented with a nontraumatic calcaneal avulsion without a previous diagnosis of ochronosis. To the best of our knowledge, little information has been reported of this pathology in the Achilles tendon and the surgical management.
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Affiliation(s)
- Oğuzhan Tanoğlu
- Specialist in Orthopaedics, Orthopaedics and Traumatology Clinics, Ankara Research and Training Hospital, Ankara, Turkey.
| | - Gökhun Arıcan
- Resident in Orthopaedics, Orthopaedics and Traumatology Clinics, Ankara Research and Training Hospital, Ankara, Turkey
| | - Ahmet Özmeriç
- Associate Professor in Orthopaedics, Orthopaedics and Traumatology Clinics, Ankara Research and Training Hospital, Ankara, Turkey
| | - Kadir Bahadır Alemdaroğlu
- Professor in Orthopaedics, Orthopaedics and Traumatology Clinics, Ankara Research and Training Hospital, Ankara, Turkey
| | - Muzaffer Çaydere
- Specialist in Pathology, Department of Pathology, Ankara Research and Training Hospital, Ankara, Turkey
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Rocchi V, Shapiro B, Fraser MR. An Osteochondral Allograft in a Patient with Ochronosis: A Case Report. JBJS Case Connect 2018; 8:e55. [PMID: 30045078 DOI: 10.2106/jbjs.cc.18.00038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE When a 31-year-old man with no prior medical history underwent diagnostic arthroscopy for posttraumatic knee pain, ochronotic arthropathy was identified. Subsequent blood tests led to the diagnosis of alkaptonuria. After a discussion regarding his future military career and prognosis, he elected to proceed with osteochondral allograft transplantation surgery (OATS). He was able to return to active-duty service with minimal knee pain. At the 32-month postoperative visit, he had functional, pain-free motion and an excellent Hospital for Special Surgery (HSS) knee score. CONCLUSION Alkaptonuria is an uncommon metabolic disorder that causes arthropathy of peripheral joints. When there is a focal defect, an osteochondral allograft is a valid, joint-preserving option that allows return to activity.
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Affiliation(s)
- Vanna Rocchi
- Department of Orthopaedic Surgery, Naval Medical Center San Diego, San Diego, California
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Gil JA, Wawrzynski J, Waryasz GR. Orthopedic Manifestations of Ochronosis: Pathophysiology, Presentation, Diagnosis, and Management. Am J Med 2016; 129:536.e1-6. [PMID: 26844634 DOI: 10.1016/j.amjmed.2016.01.010] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 01/09/2016] [Accepted: 01/13/2016] [Indexed: 11/17/2022]
Abstract
Ochronotic arthropathy occurs in patients with alkaptonuria, manifesting first in the intervertebral discs of the lumbar spine, with subsequent degeneration most often observed in the knee, hip, and shoulder joints. Efforts at treatment are targeted at minimizing the damaging effects of the underlying metabolic disorder on the articular cartilage. Vitamin E and N-acetyl cysteine are potential therapies because of their scavenging of free radicals and consequent limitation of oxidative damage to joint tissue. Arthroscopy has been found to be an effective diagnostic tool in cases of suspected ochronosis. Arthroplasty performed in patients with ochronotic arthropathy suggests that the procedure is effective in the alleviation of joint pain and the improvement of mobility. Perioperative management of these patients may require more careful consideration pertinent to the associated comorbidities of this disorder.
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Affiliation(s)
- Joseph A Gil
- Department of Orthopedic Surgery, Warren Alpert Medical School, Brown University, Providence, RI.
| | | | - Gregory R Waryasz
- Department of Orthopedic Surgery, Warren Alpert Medical School, Brown University, Providence, RI
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