Unplanned readmission after total knee arthroplasty (TKA) has an increasing prevalence in the United States. Readmissions are now a metric for hospital quality of care, yet there are mixed results and variables associated with unplanned readmission. In this changing healthcare, it is critical for community healthcare institutions to identify risk factors for unplanned readmissions following TKA. Retrospective chart review and a hospital administrative database query to report causes, demographics, and medical comorbid risk factors result in 30-day readmission after undergoing primary TKA between 2011 and 2016 at a teaching community hospital. This study identified 7,482 primary TKA procedures of which 210 (2.8%) were unplanned readmissions. Gastrointestinal bleed (9.05%) and periprosthetic infection (8.10%) were the most common causes of readmission. Age 65 and older (odds ratio [OR], 1.64; 95% confidence interval [CI], 1.21–2.21; p = 0.0012), male (OR, 1.37; 95% CI, 1.03–1.83; p = 0.0302), length of stay > 3 days (OR, 2.04; 95% CI, 1.45–2.86; p < 0.0001), and discharge to rehab (OR, 2.21; 95% CI, 1.49–3.26; p ≤ 0.0001) were correlated significantly with risk of 30-day readmission. Chronic airway disease (OR, 2.81; 95% CI, 1.54–5.14; p = 0.0008) and obesity (OR, 1.45; 95% CI, 1.006–2.10; p = 0.0463) were significant risk factors. Higher Charlson comorbidity index was not a predictor of time to readmission within 30 days after TKA.
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.
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