Download PDF
J Knee Surg 2010; 23(1): 017-020
DOI: 10.1055/s-0030-1262903
© Thieme Medical Publishers

Acute Crystal-induced Arthritis Following Arthroplasty

Amir Zadaka1 , Terence Gioe2 , Elie Gertner3
  • 1School of Nursing, University of Minnesota, University of Minnesota Medical School, Minneapolis, Minnesota
  • 2Department of Orthopaedic Surgery, VA Medical Center, Minneapolis, Minnesota
  • 3Department of Internal Medicine and Rheumatology, Regions Hospital, St. Paul, Minnesota
Further Information

Publication History

Publication Date:
15 July 2010 (online)

    Permissions and Reprints

ABSTRACT

Septic arthritis at the site of previous arthroplasty is a serious medical problem with high morbidity and mortality. Even with careful physical examination and laboratory evaluation, the diagnosis of septic arthritis may be difficult to confirm and many patients undergo operative procedures for presumed infection. In patients with previous arthroplasty, a synovial fluid white blood cell count of >2,500–3,000/mm3 in the presence of an elevated erythrocyte sedimentation rate and C-reactive protein has been reported to indicate infection with a high degree of sensitivity and specificity. However, crystal-induced disease (gout, pseudogout) may present with the extact same clinical manifestations, physical examination, and laboratory results as infection. Yet crystal-induced disease is only rarely recognized in patients with previous arthroplasty. We report two cases of acute crystal disease in patients with previous arthroplasty that mimicked infection. Review of the few additional case reports extent suggests that crystal-induced disease may occur more frequently than heretofore recognized. We therefore propose that the evaluation of acute arthritis in a patient with previous arthroplasty include systematic evaluation for crystal disease, as patients may present with septic arthritis, crystal disease, or both.

KEYWORDS

Arthroplasty - crystal arthritis - gout - pseudogout

REFERENCES

  • 1 Saag K G. Introduction—case studies in gouty arthritis.  Am J Med. 2006;  119(11A) S2
    CrossrefPubMedGoogle Scholar
  • 2 Kaandorp C JE, van Schaardenburg D, Krijnen P, Habbema J DF, Laar M AFJ. Risk factor for septic arthritis in patients with joint disease.  Arthritis Rheum. 1995;  38 1819-1825
    CrossrefPubMedGoogle Scholar
  • 3 Berbari E F, Hanssen A D, Duffy M C et al.. Risk factors for prosthetic joint infection: case-control study.  Clin Infect Dis. 1998;  27 1247-1254
    CrossrefPubMedGoogle Scholar
  • 4 Schinsky M F, Della Valle C J, Sporer S M, Paprosky W G. Perioperative testing for joint infection in patients undergoing revision total hip arthroplasty.  J Bone Joint Surg Am. 2008;  90 1869-1875
    CrossrefPubMedGoogle Scholar
  • 5 Della Valle C J, Sporer S M, Jacobs J J, Berger R A, Rosenberg A G, Paprosky W G. Preoperative testing for sepsis before revision total knee arthroplasty.  J Arthroplasty. 2007;  22(6 Suppl 2) 90-93
    CrossrefPubMedGoogle Scholar
  • 6 Mason J B, Fehring T K, Odum S M, Griffin W L, Nussman D S. The value of white blood cell counts before revision total knee arthroplasty.  J Arthroplasty. 2003;  18 1038-1043
    CrossrefPubMedGoogle Scholar
  • 7 Rand J A, Bryan R S, Morrey B F, Westholm F. Management of infected total knee arthroplasty.  Clin Orthop Relat Res. 1986;  205 75-85
    PubMedGoogle Scholar
  • 8 Williamson S C, Roger D J, Petrera P, Glockner F. Acute gouty arthropathy after total knee arthroplasty. A case report.  J Bone Joint Surg Am. 1994;  76 126-128
    Google Scholar
  • 9 Holt G, Vass C, Kumar C S. Acute crystal arthritis mimicking infection after total knee arthroplasty.  BMJ. 2005;  331 1322-1323
    CrossrefPubMedGoogle Scholar
  • 10 Archibeck M J, Rosenberg A G, Sheinkop M B, Berger R A, Jacobs J J. Gout-induced arthropathy after total knee arthroplasty: a report of two cases.  Clin Orthop Relat Res. 2001;  392 377-382
    CrossrefPubMedGoogle Scholar
  • 11 Crawford L, Kumar A, Shepard G J. Gouty synovitis after total knee arthroplasty: a case report.  J Orthop Surg (Hong Kong). 2007;  15 384-385
    PubMedGoogle Scholar
  • 12 Berger J S, Weinik M. Gout-induced arthropathy in a knee following total arthroplasty: a case report.  Arch Phys Med Rehabil. 2007;  88 E42
    PubMedGoogle Scholar
  • 13 Blyth P, Pai V S. Recurrence of gout after total knee arthroplasty.  J Arthroplasty. 1999;  14 380-382
    CrossrefPubMedGoogle Scholar
  • 14 Salin J W, Lombardi Jr A V, Berend K R, Chonko D J. Acute gouty arthropathy after total knee arthroplasty.  Am J Orthop (Belle Mead NJ). 2008;  37 420-422
    PubMedGoogle Scholar
  • 15 Sonsale P D, Philipson M R. Pseudogout after total knee arthroplasty.  J Arthroplasty. 2007;  22 271-272
    CrossrefPubMedGoogle Scholar
  • 16 Hirose C B, Wright R W. Calcium pyrophosphate dihydrate deposition disease (pseudogout) after total knee arthroplasty.  J Arthroplasty. 2007;  22 273-276
    CrossrefPubMedGoogle Scholar
  • 17 Yeh W L, Shi C H. Gout with aseptic loosening of cementless total hip arthroplasty. A case report.  Chang Gung Med J. 1994;  17 384-389
    PubMedGoogle Scholar
  • 18 Ortman B L, Pack L L. Aseptic loosening of a total hip prosthesis secondary to tophaceous gout. A case report.  J Bone Joint Surg Am. 1987;  69 1096-1099
    PubMedGoogle Scholar
  • 19 Healey J H, Dines D, Hershon S. Painful synovitis secondary to gout in the area of a prosthetic hip joint. A case report.  J Bone Joint Surg Am. 1984;  66 610-611
    PubMedGoogle Scholar
  • 20 Freehill M T, McCarthy E F, Khanuja H S. Total knee arthroplasty failure and gouty arthropathy.  J Arthroplasty. 2010;  25 658, e7-e10
    PubMedGoogle Scholar

Elie GertnerM.D. FRCP(C) FACP 

Department of Internal Medicine, 11107E, Regions Hospital

640 Jackson Street, St. Paul, MN 55101

Email: elie.x.gertner@healthpartners.com

      >