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Huffman N, Pasqualini I, Surace P, Molloy RM, Piuzzi NS, Deren ME. Diagnosis, Treatment, and Outcomes of Crystalline Arthropathy in the Setting of Total Knee Arthroplasty: A Critical Analysis Review. JBJS Rev 2023; 11:01874474-202312000-00010. [PMID: 38134288 DOI: 10.2106/jbjs.rvw.23.00163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2023]
Abstract
» Emerging evidence suggests the prevalence of crystalline arthropathy (CA) in the setting of total knee arthroplasty (TKA) is increasing, and diagnosis of CA is often intricate because of symptom overlap with other common postoperative complications such as periprosthetic joint infection (PJI). Consequently, an accurate and timely diagnosis becomes pivotal in guiding the choice of treatment.» CA includes gout and calcium pyrophosphate deposition (CPPD) disease, and accurate diagnosis in patients with prior TKA requires a multifaceted approach. The diagnosis algorithm plays a critical role in determining the appropriate treatment approach.» Management of CA typically involves a conservative strategy, encompassing the administration of nonsteroidal anti-inflammatory drugs, colchicine, and steroids, regardless of whether patients have undergone prior TKA.» There is conflicting evidence on the effect CA has on the surgical outcomes in postoperative TKA patients. While these patients may expect excellent functional outcomes and pain relief, they may be at a higher risk of complications such as infections, medical complications, and revision procedures.» Additional research is required to fully comprehend the impact of CA on postoperative TKA outcomes and to establish effective strategies for enhancing patient care and optimizing long-term joint function.
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Affiliation(s)
- Nickelas Huffman
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | | | - Peter Surace
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Robert M Molloy
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Nicolas S Piuzzi
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio
- Department of Biomedical Engineering, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Matthew E Deren
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio
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2
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Cole M, Patel A, Collins L, Hawkins B, Sherman WF. Pseudogout After Total Knee Arthroplasty Meeting Minor Criteria for Infection Treated by Polyethylene Exchange. Orthop Rev (Pavia) 2023; 15:67912. [PMID: 36776277 PMCID: PMC9907320 DOI: 10.52965/001c.67912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Case Pseudogout in a total joint arthroplasty is rare and can be difficult to distinguish from a prosthetic joint infection (PJI). In this unique case, we present a patient who developed her first episode of pseudogout 17 years after her primary total knee arthroplasty at age 75. Conclusion With similar clinical and laboratory findings, it is important to distinguish the presence of PJI and inflammatory arthropathy. The use of diagnostic tools available, consideration of patient co-morbidities, and timing of symptoms can help guide surgeons' treatment.
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Affiliation(s)
- Matthew Cole
- Orthopaedic SurgeryTulane University School of Medicine
| | - Akshar Patel
- Orthopaedic SurgeryTulane University School of Medicine
| | - Lacee Collins
- Orthopaedic SurgeryTulane University School of Medicine
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Forlizzi JM, Ryan JM, Galow KE, Shang AC, Polakoff DR. Acute pseudogout presenting as an exception to Musculoskeletal Infection Society criteria in total knee arthroplasty: a case report. AME Case Rep 2020; 4:21. [PMID: 33178993 DOI: 10.21037/acr-20-82] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 05/22/2020] [Indexed: 12/17/2022]
Abstract
In this case, a 78-year-old female with no previous medical history of crystalline arthropathy presented with pain, effusion, and erythema about a total knee arthroplasty (TKA) performed 13 years prior. Implementation of a novel synovial fluid alpha-defensin assay ruled out periprosthetic joint infection (PJI) despite a positive 2018 Musculoskeletal Infection Society (MSIS) minor criteria score of 8 points, a significant diagnostic differentiation which prevented secondary invasive debridement or joint irrigation intervention. Confirmatory histologic study was positive for calcium pyrophosphate crystals, indicative of acute pseudogout inflammation rather than PJI or septic arthritis manifestation. The patient was then conservatively managed medically for a pseudogout flare and had no evidence of infection with normal physical exam and laboratory study at one- and two-years post treatment, respectively. Given the predominantly clinical nature of current PJI assessment in-clinic coupled with notable risks associated with aggressive re-intervention in the setting of suspected infection, critical need exists for the maturation of sensitive, reliable empiric measures which may assist in guiding orthopaedic surgeon evaluation of patients presenting with inflammatory symptomology around a previous surgical site. In this case, we conclude that patients with a negative alpha-defensin assay alongside crystalline arthropathy on histology may be cautiously yet successfully treated non-operatively despite clinical MSIS criteria concerning for PJI.
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Affiliation(s)
| | - James M Ryan
- Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | | | - Aaron C Shang
- University of Oxford Medical Sciences Division, Oxford, Oxfordshire, UK.,Hackensack Meridian School of Medicine, Nutley NJ, USA
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Chernoff DJ, Barker JP, Wingerter SA, Shriwise TL. Gout After Total Knee Arthroplasty. Arthroplast Today 2020; 6:278-282. [PMID: 32577478 PMCID: PMC7303497 DOI: 10.1016/j.artd.2020.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 03/01/2020] [Accepted: 03/05/2020] [Indexed: 11/17/2022] Open
Abstract
Crystalline arthropathies are well-known pathologies in a native knee; however, the literature is scarce with regards to crystalline arthropathies in a total knee arthroplasty (TKA). The presentation of crystalline arthropathy in a TKA can be similar to a periprosthetic joint infection (PJI), making it difficult to distinguish between the 2 diagnoses. We present 1 case highlighting the similarity between crystalline arthropathy and PJI. A 71-year-old man with a history of bilateral TKAs presented with bilateral painful knee effusions and was initially presumed to have PJIs; however, he was later diagnosed with gout and successfully treated medically. A complete review of the literature demonstrates that crystalline arthropathies after TKA are infrequently reported and can be difficult to decipher from PJIs, and there is a lack of standardized treatment.
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Affiliation(s)
- Daniel J Chernoff
- Department of Orthopaedic Surgery, University of Missouri-Kansas City, St. Luke's Hospital, Kansas City, MO, USA
| | - Jordan P Barker
- Department of Orthopaedic Surgery, University of Missouri-Kansas City, St. Luke's Hospital, Kansas City, MO, USA
| | - Scott A Wingerter
- Department of Orthopaedic Surgery, University of Missouri-Kansas City, St. Luke's Hospital, Kansas City, MO, USA
| | - Thomas L Shriwise
- Department of Orthopaedic Surgery, University of Missouri-Kansas City, St. Luke's Hospital, Kansas City, MO, USA
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5
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Crystal Arthropathy in the Setting of Total Knee Arthroplasty. Case Rep Orthop 2020; 2020:7613627. [PMID: 32257485 PMCID: PMC7128041 DOI: 10.1155/2020/7613627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 03/09/2020] [Indexed: 11/18/2022] Open
Abstract
We present a case of an 82-year-old female with a history of right total knee arthroplasty 11 years prior. She was admitted after a ground-level fall and developed progressive pain and swelling of her right knee. She had no history of complications with her total knee replacement. Radiographs of the knee and hip were negative for acute fracture, dislocation, or hardware malalignment. Knee aspiration was performed and revealed inflammatory exudate, synovial fluid consistent with crystal arthropathy, and no bacterial growth. She was diagnosed with an acute gout flare, and her symptoms significantly improved with steroids and anti-inflammatory treatment. Orthopedic surgeons should be aware of the potential for crystal arthropathy in the setting of total joint arthroplasty and evaluate for crystals before treating a presumed periprosthetic joint infection.
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Dang LHN, Kim JK, Lee KB. Crystal-Induced Arthritis After Total Ankle Arthroplasty. J Am Podiatr Med Assoc 2019; 109:159-161. [PMID: 31135198 DOI: 10.7547/17-097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The causes of late-onset pain after total ankle replacement (TAR) are various, and include infection, subsidence, polyethylene spacer failure, osteolysis, and wear. There are few reports of late-onset pain caused by gouty attacks after total knee and hip arthroplasty. In addition, no research has reported gouty attacks after total ankle arthroplasty. Therefore, we report a case of a gouty attack after total ankle replacement. A 43-year-old man presented with pain after total ankle arthroplasty performed 5 years previously. We found a white-yellow crystalline deposit within the synovial tissue during ankle arthroscopy, confirmed by histologic examination.
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Affiliation(s)
- Le Hoang Nam Dang
- Department of Orthopedic Surgery, Chonbuk National University Medical School, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Hospital, Jeonju, Republic of Korea
| | - Jong-Kil Kim
- Department of Orthopedic Surgery, Presbyterian Medical Center, Jeonju, Republic of Korea
| | - Kwang-Bok Lee
- Department of Orthopedic Surgery, Chonbuk National University Medical School, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Hospital, Jeonju, Republic of Korea
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Argyropoulos M, Iyengar KP, Suraliwala KH. First Presentation of Acute Pseudogout Following Total Knee Replacement. J Orthop Case Rep 2019; 8:32-34. [PMID: 30687658 PMCID: PMC6343566 DOI: 10.13107/jocr.2250-0685.1146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: Infection of a total knee replacement (TKR) is a very serious complication of knee arthroplasty surgery as the repercussions for the patient often include long-term antibiotics, further surgery, revision surgery, and worse outcomes in the long-term including increased morbidity and mortality. As such, the careful assessment of a patient presenting with an acutely inflamed TKR is of paramount importance. Case Report: We report a case of a patient presenting with the clinical signs and symptoms of an acute infection of their TKR. The patient was ultimately diagnosed as having pseudogout. Conclusion: This case illustrates that crystal arthropathy must be one of the differential diagnoses for a suspected infection of a TKR, as failure to recognize this may result in unnecessary and detrimental treatment.
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Affiliation(s)
- Miltiadis Argyropoulos
- Department of Trauma and Orthopaedics, Southport & Ormskirk NHS Trust, Southport, England
| | - K P Iyengar
- Department of Trauma and Orthopaedics, Southport & Ormskirk NHS Trust, Southport, England
| | - K H Suraliwala
- Department of Trauma and Orthopaedics, Southport & Ormskirk NHS Trust, Southport, England
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George MP, Ernste FC, Tande A, Osmon D, Mabry T, Berbari EF. Clinical Presentation, Management, and Prognosis of Pseudogout in Joint Arthroplasty: A Retrospective Cohort Study. J Bone Jt Infect 2019; 4:20-26. [PMID: 30755844 PMCID: PMC6367192 DOI: 10.7150/jbji.29983] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Accepted: 12/06/2018] [Indexed: 12/24/2022] Open
Abstract
Introduction: Calcium pyrophosphate deposition disease (CPPD), or pseudogout, is rare in prosthetic joints, but can mimic prosthetic joint infection (PJI) according to case reports. The purpose of this case series is to describe the demographics, presentation, management, and outcomes of a cohort of these patients seen at our academic medical center. Methods: Patients with post-implant pseudogout, who were evaluated at our medical center between January 1, 2000 and June 30, 2016, were identified from our EHR. Data pertaining to demographics, presentation, management, and outcomes were abstracted, and patients were categorized into two groups based on presence of concomitant infection along with positive CPDD findings in synovial fluid. Results: 22 patients were included. 90.9% of cases involved a TKA. The most common indication for arthroplasty was degenerative joint disease. Only four patients had a history of previous gout or pseudogout, three of which belonged to the group with no evidence of concomitant joint infection. Clinical features for patients without concomitant infection included pain (100%), swelling at the joint (88.9%), redness (33.3%), fever (22.2%), and decreased range of motion (100%). 45.5% of patients received antibiotics prior to joint aspiration (44.4% of patients with negative synovial fluid cultures, 46.2% of patients with concomitant infection). Conclusion: Our study suggests similar clinical presentation between post-implant pseudogout and PJI. Among patients with pseudogout as well as in those with PJI, the first dose of antibiotics should not be given before sampling for synovial culture. Unfortunately, many patients receive antibiotics prior to culture ascertainment, which raises concern for antibiotic overuse.
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Affiliation(s)
- Merit P George
- Mayo Clinic School of Medicine. 200 1st St SW, Rochester, MN 55905
| | - Floranne C Ernste
- Division of Rheumatology, Department of Internal Medicine, Mayo Clinic School of Graduate Medical Education. 200 1st St SW, Rochester, MN 55905
| | - Aaron Tande
- Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic School of Graduate Medical Education. 200 1st St SW, Rochester, MN 55905
| | - Douglas Osmon
- Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic School of Graduate Medical Education. 200 1st St SW, Rochester, MN 55905
| | - Tad Mabry
- Division of Orthopedic Surgery, Department of Surgery, Mayo Clinic School of Graduate Medical Education. 200 1st St SW, Rochester, MN 55905
| | - Elie F Berbari
- Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic School of Graduate Medical Education. 200 1st St SW, Rochester, MN 55905
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Lyme periprosthetic joint infection in total knee arthroplasty. Arthroplast Today 2018; 4:158-161. [PMID: 29896545 PMCID: PMC5994602 DOI: 10.1016/j.artd.2017.12.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 12/11/2017] [Accepted: 12/12/2017] [Indexed: 12/12/2022] Open
Abstract
Lyme arthritis, caused by the spirochete Borrelia burgdorferi sensu stricto, is a common tick-borne illness in New England and the upper Midwest. Most often, the disease affects the knee and has typically been reported as a cause of native joint infection. There has been only 1 case of Lyme periprosthetic joint infection (associated with a total knee arthroplasty) reported in the literature, and to our knowledge, no other reported cases of Lyme periprosthetic joint infections exist. In this article, we report on 2 patients diagnosed with prosthetic joint infections who were subsequently found to have Lyme prosthetic joint infections, with B burgdorferi as the infectious organism. We discuss the medical and surgical management of these patients.
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Concomitant Parvimonas micra Septic Arthritis and Pseudogout After Total Knee Arthroplasty. J Clin Rheumatol 2018; 25:47-50. [PMID: 29470261 DOI: 10.1097/rhu.0000000000000728] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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11
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Calcium Pyrophosphate Dihydrate Deposition Disease in a Knee With Total Joint Replacement. J Clin Rheumatol 2017; 22:277. [PMID: 27464775 DOI: 10.1097/rhu.0000000000000384] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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12
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Bridges KJ, Bullis CL, Wanchu A, Than KD. Pseudogout of the cervical and thoracic spine mimicking infection after lumbar fusion: case report. J Neurosurg Spine 2017; 27:145-149. [PMID: 28524751 DOI: 10.3171/2016.12.spine16979] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Pseudogout is a form of acute calcium pyrophosphate deposition (CPPD) disease that typically afflicts the elderly. CPPD commonly involves larger joints, such as the knees, wrists, shoulders, and hips, and has been known to involve the spine. The authors report the case of a 66-year-old woman with a recent history of lumbar laminectomy and fusion who presented 5 weeks postprocedure with a clinical and radiographic picture consistent with multilevel skip lesions involving the cervical and thoracic spine, thoracic discitis, and epidural abscess. Serial blood cultures and repeat biopsy samples were sterile. Subsequent wrist and ankle erythema, pain, and swelling led to synovial fluid analysis, and pseudogout was diagnosed. She was treated with an interleukin-1 inhibitor with immediate symptom relief. To the authors' knowledge, this is only the second report of spinal pseudogout presenting with a clinical and radiographic picture consistent with discitis and epidural abscess. This report is the first to report skip lesions of pseudogout occurring throughout the spine that are uniquely remote from a recent lumbar surgery.
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Affiliation(s)
| | | | - Ajay Wanchu
- Division of Arthritis & Rheumatic Diseases, Department of Medicine, Oregon Health & Science University, Portland, Oregon
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13
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Testa EJ, McGrory BJ. Adverse reaction to metal debris with concomitant incidental crystalline arthropathy in hip arthroplasty. Arthroplast Today 2017; 3:19-23. [PMID: 28378001 PMCID: PMC5365402 DOI: 10.1016/j.artd.2016.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 10/24/2016] [Indexed: 11/16/2022] Open
Abstract
Adverse reaction to metal debris (ARMD) is a known cause of failed metal in hip arthroplasty. Diagnosis of this type of prosthesis failure may be difficult, and the hallmark is an abnormally elevated serum cobalt level. Concomitant diagnoses may also be present, such as infection, instability, and loosening, and this may confuse interpretation of abnormal laboratories. We present here, for the first time, 2 patients with ARMD and crystalline arthropathy. In each case, the patient chose surgery for ARMD, with resolution of symptoms and no recurrence of the crystalline arthropathy. We present these cases to alert the orthopaedist that crystalline arthropathy may be present at the same time as ARMD, but is likely not the primary cause of symptoms.
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Affiliation(s)
| | - Brian J. McGrory
- Tufts University School of Medicine, Boston, MA, USA
- Division of Joint Replacement Surgery, Maine Medical Center and Maine Joint Replacement Institute, Portland, ME, USA
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15
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Lee GC, Lotke PA. Does chondrocalcinosis affect Knee Society scores and range of motion after TKA? Clin Orthop Relat Res 2014; 472:1512-7. [PMID: 24385044 PMCID: PMC3971233 DOI: 10.1007/s11999-013-3447-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 12/20/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND Chondrocalcinosis is manifested by crystalline deposits of calcium commonly found during primary TKA for osteoarthritis. Its frequency among patients undergoing TKA is poorly defined, as is its influence on pain or function after TKA. QUESTIONS/PURPOSES The purposes of this study are to (1) determine the prevalence of chondrocalcinosis in patients undergoing TKA for osteoarthritis; (2) evaluate the effect of chondrocalcinosis on ROM and The Knee Society scores; (3) determine if patients with chondrocalcinosis and severe synovitis who underwent synovectomy are at risk for lower postoperative Knee Society scores and less ROM; and (4) assess if chondrocalcinosis is associated with increased rates of revision surgery. METHODS We retrospectively reviewed the medical records of 1500 primary TKAs performed by one surgeon. The minimum followup for patients was 24 months (average, 57 months; range, 24-120 months). There were 511 men and 934 women with an average age of 70 years. Fifty-five patients underwent bilateral knee replacements. Crystal deposition was graded prospectively during surgery using a subjective visual scale. A thorough synovectomy was performed on patients with severe synovitis and apparent crystalline deposition suggestive of calcium pyrophosphate dihydrate (CPPD) deposition (n = 50). The Knee Society scores, ROM, and revision rates were compared between patients with visible chondrocalcinosis with those without and between patients with mild chondrocalcinosis with those with severe chondrocalcinosis. RESULTS Chondrocalcinosis was found in 173 male patients (34%) undergoing TKAs during this period compared with 224 female patients (24%) (p < 0.001). The Knee Society scores for knee rating and function were similar in patients with or without chondrocalcinosis undergoing TKA. However, patients with visible CPPD deposition who underwent synovectomy for proliferative synovitis had diminished final ROM and Knee Society knee rating scores (107(o) versus 115(o) knee flexion, p < 0.001 and 87 versus 94 points, p = 0.001). We cannot determine whether this result is because of the synovectomy or severity of the disease, and therefore we cannot recommend a synovectomy at this time. Revision rates were no different among patients with chondrocalcinosis compared with those without it (3.6% versus 2.2%, p = 0.2). CONCLUSIONS Chondrocalcinosis is common among patients undergoing TKA for osteoarthritis. The presence of CPPD deposition does not appear to affect the ROM and Knee Society scores of patients with CPPD but without severe synovitis. However, patients with severe synovitis and visible CPPD who underwent thorough synovectomy may be at risk for having decreased postoperative ROM and pain develop. LEVEL OF EVIDENCE Level III, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Gwo-Chin Lee
- Department of Orthopedic Surgery, University of Pennsylvania, 1 Cupp Pavilion, 39th and Market Streets, Philadelphia, PA, 19104, USA,
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Helito CP, Noffs GG, Pecora JR, Gobbi RG, Tirico LEP, Lima ALM, de Oliveira PR, Camanho GL. Epidemiology of septic arthritis of the knee at Hospital das Clínicas, Universidade de São Paulo. Braz J Infect Dis 2013; 18:28-33. [PMID: 24029436 PMCID: PMC9425218 DOI: 10.1016/j.bjid.2013.04.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2013] [Revised: 03/26/2013] [Accepted: 04/11/2013] [Indexed: 12/31/2022] Open
Abstract
Background Septic arthritis is an infrequent disease although very important due to the possibility of disastrous outcomes if treatment is not adequately established. Adequate information concerning the epidemiology of septic arthritis is still lacking due to the uncommon nature of the disease as well as the struggle to establish a correct case-definition. Objective To epidemiologically characterize the population seen at Hospital das Clínicas, University of São Paulo with a diagnosis of septic arthritis between 2006 and 2011. Methods Sixty-one patients diagnosed with septic arthritis of the knee between 2006 and 2011 were retrospectively evaluated. The patients’ clinical and epidemiological characteristics, the microorganisms that caused the infection and the patients’ treatment and evolution were analyzed. Results Septic arthritis of the knee was more common among men, with distribution across a variety of age ranges. Most diagnoses were made through positive synovial fluid cultures. The most prevalent clinical comorbidities were systemic arterial hypertension and diabetes mellitus, and the most commonly reported joint disease was osteoarthritis. Staphylococcus aureus was the prevailing pathogen. Fever was present in 36% of the cases. All patients presented elevation in inflammatory tests. Gram staining was positive in only 50.8% of the synovial fluid samples analyzed. Six patients presented complications and unfavorable evolution of their condition. Conclusion S. aureus is still the most common pathogen in acute knee infections in our environment. Gram staining, absence of fever and normal leukocyte count cannot be used to rule out septic arthritis.
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Affiliation(s)
- Camilo Partezani Helito
- Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (IOT-HCFMUSP), São Paulo, SP, Brazil.
| | - Guilherme Guelfi Noffs
- Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (IOT-HCFMUSP), São Paulo, SP, Brazil
| | - Jose Ricardo Pecora
- Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (IOT-HCFMUSP), São Paulo, SP, Brazil
| | - Riccardo Gomes Gobbi
- Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (IOT-HCFMUSP), São Paulo, SP, Brazil
| | - Luis Eduardo Passarelli Tirico
- Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (IOT-HCFMUSP), São Paulo, SP, Brazil
| | - Ana Lucia Munhoz Lima
- Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (IOT-HCFMUSP), São Paulo, SP, Brazil
| | - Priscila Rosalba de Oliveira
- Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (IOT-HCFMUSP), São Paulo, SP, Brazil
| | - Gilberto Luis Camanho
- Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (IOT-HCFMUSP), São Paulo, SP, Brazil
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Swayamprakasam AP, Taqvi S, Hossain S. A case of mistaken identity: pseudogout in a prosthetic knee. Br J Hosp Med (Lond) 2013; 74:54-5. [PMID: 23593681 DOI: 10.12968/hmed.2013.74.1.54] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Pseudogout in the early postoperative period after total knee arthroplasty. J Arthroplasty 2013; 28:374.e9-374.e11. [PMID: 22522109 DOI: 10.1016/j.arth.2012.03.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Accepted: 03/13/2012] [Indexed: 02/01/2023] Open
Abstract
Postoperative pseudogout after total knee arthroplasty is rare. If pseudogout attacks are misdiagnosed as periprosthetic sepsis, patients may undergo unnecessary surgical procedures. We report a case of pseudogout in the early postoperative period. The attack ensued shortly after a nonsteroidal antiinflammatory drug was discontinued. The diagnosis was confirmed by aspiration, and the patient improved after readministration of the nonsteroidal antiinflammatory drug. Although rare, pseudogout should be considered in the differential when approaching a suspected infection after total knee arthroplasty.
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Levi GS, Sadr K, Scuderi GR. Bilateral pseudogout 8 years after bilateral total knee arthroplasty. Orthop Clin North Am 2012; 43:e59-62. [PMID: 23102423 DOI: 10.1016/j.ocl.2012.07.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
This article presents the clinical features of crystal arthropathy after knee replacement. The current literature on pseudogout and gout after both total and partial knee replacement is summarized. A case of bilateral pseudogout 8 years after initial total knee arthroplasty (TKA) is used to highlight the clinical characteristics and treatment options for this underrecognized condition. Presentation mimicked a late septic joint arthroplasty with sudden onset of pain and effusion. The patient was treated successfully with an arthrotomy, debridement, synovectomy, polyethylene insert exchange, oral steroids, and nonsteroidal anti-inflammatories. There are no other reported cases of bilateral pseudogout after bilateral TKA.
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Affiliation(s)
- Gabriel S Levi
- Department of Orthopaedic Surgery, University of Illinois, Chicago, IL 60612, USA
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Carter JL, Endres NK, Halsey DA. Bilateral Acute Calcium Pyrophosphate Crystal Arthritis After Bilateral Total Knee Arthroplasty: A Case Report. JBJS Case Connect 2012; 2:e59. [PMID: 29252355 DOI: 10.2106/jbjs.cc.k.00167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Joshua L Carter
- Department of Orthopaedics and Rehabilitation, University of Vermont, Stafford Hall 4th Floor, 95 Carrigan Drive, Burlington, VT 05401. .
| | - Nathan K Endres
- Department of Orthopaedics and Rehabilitation, University of Vermont, Stafford Hall 4th Floor, 95 Carrigan Drive, Burlington, VT 05401. .
| | - David A Halsey
- Orthopedic Specialty Center, 192 Tilley Drive, South Burlington, VT 05403.
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Koyama K, Ohba T, Sato H, Haro H. Pseudogout Mimicking Infection Following Total Knee Arthroplasty: A Report of Two Cases. JBJS Case Connect 2012; 2:e3. [PMID: 29252454 DOI: 10.2106/jbjs.cc.k.00049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Kensuke Koyama
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi 409-3898, Japan. . . .
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