Allergic reactions to metals following joint arthroplasty represent a rare and poorly understood phenomenon. Much is still unknown regarding the natural history of this complication, and how it can best be prevented and managed. We present a case of a 68-year-old woman who underwent a left total knee arthroplasty for treatment of osteoarthritis. After an initial uneventful postoperative course, she developed a troublesome erythematous rash both around the incision site and over her trunk. Blood testing revealed no evidence of infection and clinically her prosthesis was functioning well. Skin patch testing revealed positive results for vanadium (+) and palladium (+). Her cutaneous symptoms are currently being managed conservatively and have shown a partial response to topical steroids. Revision surgery remains a long-term treatment option should conservative therapy fail; however, it would require a custom-made prosthesis as no standard tibial component is free from vanadium.
Background:
A hot, swollen joint is a common clinical condition encountered in the ED
and elective orthopaedic and rheumatology clinics. These patients can be difficult to manage and
properly treat.
Aims and Objectives:
The aim of this study was to report a single centre retrospective analysis of
patients presenting to our institution for a hot, swollen joint over a three-month period.
Methods:
The study included patients presenting with a hot, swollen joint to ED or electively to
clinics. The synovial fluid was aspirated and sent for microbiological and cytological investigation.
P value was set to < 0.001. 36 patients (22 M, 14 F) with a mean age of 72.8 ± 17.4 years met our
criteria. 20 cases (55.6 %) involved the knee joint, the wrist in 10 cases (27.8%), the elbow in 3
cases (8.3%) and the shoulder in 3 cases (8.3%).
Results:
Of the 36 synovial fluid samples collected, only 7 (19.4%) reported evidence of infection.
On cytological examination of the synovial fluid, 21 (58.3%) reported presence of calcium pyrophosphates
crystals (Pseudogout), 4 (11.1 %) reported presence of uric acid crystals (Gout) and 11
(30.5%) reported absence of crystals. We found a significant correlation between age and the diagnosis
of pseudogout and between previous antibiotic treatment and ED presentation. Our study
sheds light on the high incidence of crystal-related pathologies.
Conclusion:
In order to improve our management of this common condition and enhance our understanding
of the clinical diagnosis in certain patient population, further high-profile clinical studies
are needed.
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