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Resident: A typical case of gout arthropathy after a total knee arthroplasty
EP30862
Poster Title: Resident: A typical case of gout arthropathy after a total knee arthroplasty
Submitted on 18 Oct 2019
Author(s): Christine Tolu-Ajayi, MD, MSc ; Oguchi Andrew Nwosu MD FAAFP
Affiliations: mory Family Medicine Residency
Poster Views: 351
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Poster Information
Abstract: Background: Gout in a replaced joint is rare and can present as an acutely or chronically painful knee or hip. It can be difficult to differentiate between gout and an acute infection of a replaced joint as both presentations are very similar.

Case description: A 66-year-old female with a past medical history of hypertension, diabetes, Heart failure with reduced ejection fraction (10-15%), Chronic obstructive pulmonary disease and Gout presented to the emergency department with right knee pain for 2 days. She denies any trauma to the knee, reports worsening swelling and tenderness of the knee. She does report an episode of gout in the right toe approximately 6 months prior. She had bilateral total knee replacement in 2010. Knee arthrocentesis was positive for urate crystals. She was treated with oral glucocorticoids, once a septic joint was ruled out. Her symptoms improved and she was discharged to follow up with her primary care physician.

Discussion/ Conclusion: Gout can occur in a prosthetic joint. It is rare and only a handful of published case reports for gouty arthritis in a replaced joint exist, however, it may be underreported or misdiagnosed. Gouty arthritis is a manifestation of a metabolic disease and can reactivate at any point after surgery. Although rare in a replaced joint, it is important to rule out gout and test for crystals in a replaced joint presenting with septic arthritis type symptoms.
Summary: Gout in a replaced joint is rare and can present as an acutely or chronically painful knee or hip. Gout vs an acute infection of a replaced joint can be difficult to differentiate given both have similar presentations.References: Archibeck MJ, Rosenberg AG, Sheinkop MB, Berger RA, Jacobs JJ. Gout-induced arthropathy after total knee arthroplasty: a report of two cases. Clin Orthop Relat Res 2001;392:377–82. 3.
Blyth P, Pai VS. Recurrence of gout after total knee arthroplasty. J Arthroplasty 1999;14:380–2.
Qaseem A, Harris RP, Forciea MA, Clinical Guidelines Committee of the American College of Physicians. Management of Acute and Recurrent Gout: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med 2017; 166:58.
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