Total knee arthroplasty failure and gouty arthropathy.
ABSTRACT We present a patient with gout and a total knee arthroplasty that failed secondary to infection. The English literature records only 5 other cases of gouty attacks after total knee arthroplasty. Symptoms, presentation, and laboratory tests do not definitively differentiate between infection and gout, but crystals in the joint aspirate are diagnostic. This case stresses the importance of recognizing crystalline arthropathy as a source of a painful knee and as a complicating factor during revision surgery.
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ABSTRACT: This article presents the case of a patient with pain associated with a total hip replacement. Following aspiration microscopy, a diagnosis of gout in a total hip replacement was made. Successful treatment was instituted with medical management in the presence of coexisting aseptic loosening. Gout in a total hip replacement is an exceptionally rare diagnosis. The gold standard for diagnosis is not urate level but crystal identification in the synovial fluid. The authors would therefore recommend that as part of a thorough workup for painful prosthetic joint requiring revision, a present or past history of gout is sought and a fluid aspirate should be examined not only for infection but also under polarized light for crystal arthropathy.Geriatric orthopaedic surgery & rehabilitation. 09/2010; 1(1):36-7.