Crystalline-Induced Arthropathy Following Total Knee Replacement

Abstract

Gout rarely occurs in the setting of prior total joint replacement. It can present as an acute or chronic painful joint that may mimic prosthetic joint infection with further similarities found on physical examination and initial workup. Elevated leukocyte count, erythrocyte sedimentation rate, and C-reactive protein are common to both conditions. The confirmatory test to distinguish infection versus inflammatory arthropathy is joint aspiration with crystal or micro-organism identification microscopically. Establishing proper diagnosis is important in guiding appropriate treatment, which may prevent the unnecessary removal of implants. The current study includes a review of the literature and presents a case of bilateral gouty arthropathy after total knee arthroplasty.

Keywords: arthroplasty; crystal arthropathy; gout; knee; painful total knee; total knee replacement (tkr).

Figure 1. Anteroposterior radiograph of the right knee in a patient presenting with acute crystal-induced arthritis.

Figure 2. Lateral radiograph of the right knee in a patient presenting with acute crystal-induced arthritis.

Figure 3. High-power magnification photomicrograph showing inflamed synovium of the right knee and polymorphonuclear cell infiltrate (arrows).

Figure 4. Low and high power magnification of synovial biopsy of the right knee in showing gouty tophi.