Acute Crystal-induced Arthritis Following Arthroplasty

Abstract

Septic arthritis at the site of previous arthroplasty is a serious medical problem with high morbidity and mortality. Even with careful physical examination and laboratory evaluation, the diagnosis of septic arthritis may be difficult to confirm and many patients undergo operative procedures for presumed infection. In patients with previous arthroplasty, a synovial fluid white blood cell count of >2,500-3,000/mm 3 in the presence of an elevated erythrocyte sedimentation rate and C-reactive protein has been reported to indicate infection with a high degree of sensitivity and specificity. However, crystalinduced disease (gout, pseudogout) may present with the extact same clinical manifestations, physical examination, and laboratory results as infection. Yet crystal-induced disease is only rarely recognized in patients with previous arthroplasty. We report two cases of acute crystal disease in patients with previous arthroplasty that mimicked infection. Review of the few additional case reports extent suggests that crystal-induced disease may occur more frequently than heretofore recognized. We therefore propose that the evaluation of acute arthritis in a patient with previous arthroplasty include systematic evaluation for crystal disease, as patients may present with septic arthritis, crystal disease, or both.

Crystal Arthropathy following Knee Arthroplasty: A Review of the Literature

“…Joint movements were universally restricted on admission across the studies reviewed, and this was more pronounced amongst pseudogout patients with a mean reported range of motion of 57°, see table 3. [12] P Blyth & V S Pai [13] M J Archibeck et al [14] G Roberts [15] L Crawford et al [16] J C Rompen et al [17] J W Salin et al [18] J S Berger et al [19] S K Fokter et al [20] M T Freehill et al [21] A Zadaka et al [22] S Soloway [23] [25] G Holt et al [26] C Hirose & R Wright [27] P Sonsale et al [28] J L Carter et al [29] T Hunte et al [30] K Koyama et al [31] G Levi et al [32] K Harato& H Yoshida [33] Article Type Case Series ( …”

Gout As a Predictor of Total Knee Arthroplasty Outcomes and Costs

“…A body of case reports describe attacks of gouty arthritis after TKA, with some successfully managed medically and some requiring revision surgery. [7][8][9][10][11] A recent study using an institutional database including a total of 482 patients with gout undergoing total joint arthroplasty did find increased rates of wound healing problems and renal complications in the gout cohort as well as increased 90-day readmission rates in gout patients undergoing total hip arthroplasty. 12 Nevertheless, to our knowledge, there is no national database study in the English literature evaluating outcomes of patients with gout after TKA.…”

Review Article: Joint Aspiration for Diagnosis of Periprosthetic Infection

“…False positive results in crystal-induced arthritis has been reported. 31,32 The sensitivities, specificities, negative predictive values, and positive predictive values of the tests are comparable in patients with inflammatory arthritis and noninflammatory arthritis. The optimal cut-offs for inflammatory and non-inflammatory arthritis are 3500/μL and 3400/μL for synovial fluid white cell count, and 88.5% and 85.1% for neutrophil percentage, * Presence of one or more of the following features: clinical or radiological suspicion of infection, erythrocyte sedimentation rate of >30 mm/h and C-reactive protein of >10 mg/l, presence of any disorder that can raise inflammatory markers, a history of wound infection, implant failure less than 5 years after arthroplasty …”