Nonoperative Treatment of a Periprosthetic Gout Flare in the Setting of a Positive Alpha-Defensin Result

Abstract

Gout is a rare cause of pain after total knee arthroplasty, and its presentation can be difficult to distinguish from a prosthetic joint infection. We describe a patient with left knee pain that had a history of gout and left total knee arthroplasty. Synovial fluid demonstrated monosodium urate crystals and positive alpha-defensin assay. Surgery was not pursued given a low clinical suspicion for infection and negative cultures. Her symptoms improved and ultimately resolved. There are limited case reports of periprosthetic aseptic gout flare, and only one case of concomitant positive alpha-defensin assay and monosodium urate crystals in a patient treated surgically. This case raises the possibility that patients with periprosthetic crystal arthropathy and a positive alpha-defensin test can be managed nonoperatively in the appropriate setting.

Keywords: Alpha-defensin assay; Gout; Prosthetic joint infection; Total knee arthroplasty.

Figure 1

Anteroposterior (a) and lateral (b) radiographs of the left knee in a 61-year-old female who had undergone a cemented left total knee arthroplasty 5 years prior.