Chondrocalcinosis does not affect functional outcome and prosthesis survival in patients after total or unicompartmental knee arthroplasty: a systematic review

Abstract

Purpose There are contentious data about the role calcium pyrophosphate (CPP) crystals and chondrocalcinosis (CC) play in the progression of osteoarthritis (OA), as well as in the outcomes after knee arthroplasty. Hence, the purpose of this systematic review was to analyse the clinical and functional outcome, progression of OA and prosthesis survivorship after unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA) in patients with CC compared to patients without CC. Methods A systematic review of the literature in PubMed, Medline, Embase and Web of Science was performed using the “Preferred Reporting Items for Systematic Reviews and Meta-Analysis” (PRISMA) guidelines. Articles which reported the outcome and survival rates of prosthesis after TKA or UKA in patients with CC were included. Results A total of 3718 patient knees were included in eight selected publications, with a median sample sizes of 234 knees (range 78–1000) and 954 knees (range 408–1500) for publications including UKA and TKA, respectively. At time of surgery, the mean age was 69 years and the prevalence for CC ranged from 12.6 to 36%. Chondrocalcinosis did not significantly influence the functional and clinical outcome, the implant survival as well as the radiologic progression of OA disease after UKA and TKA. Conclusion The presence of CPP crystals in tissue samples, synovial fluid or evidence of calcifications on preoperative radiographs did not significantly influence the postoperative functional and activity scores. It also had no significant influence on prosthesis survival rate, whether it was a UKA or a TKA. This study shows that the impact of a subclinical form of chondrocalcinosis may not be of clinical relevance in the context of arthroplasty. Level of evidence IV.

Diagnosis, Treatment, and Outcomes of Crystalline Arthropathy in the Setting of Total Knee Arthroplasty

“…A systematic review was conducted to investigate patients undergoing TKA, wherein they were categorized into 2 distinct groups: individuals diagnosed with CPPD disease and those without. The study found that functional scores and pain improved equally between the 2 groups 66 . Furthermore, there was no significant difference in total revision rates, range of motion, or Knee Society Score (KSS) between patients with and without CPPD disease 66 .…”

“…The study found that functional scores and pain improved equally between the 2 groups 66 . Furthermore, there was no significant difference in total revision rates, range of motion, or Knee Society Score (KSS) between patients with and without CPPD disease 66 . Another study found that CPPD disease, without severe synovitis, had no associated effect on postoperative range of motion and KSS after TKA 75 .…”

“…There is a dearth of literature regarding the treatment of CA exacerbations in postoperative unicompartmental knee arthroplasty (UKA) patients. However, in the available literature, patients with CA who undergo UKA show long-term implant survivorship, functional, and clinical outcomes that are comparable with patients without CA undergoing UKA 66,67 . Pandit et al 68 found similar results and concluded that CA should not be considered as a contraindication to UKA.…”

“…Another study found that CPPD disease, without severe synovitis, had no associated effect on postoperative range of motion and KSS after TKA 75 . Similarly, there are many case studies in which postoperative TKA patients achieved successful clinical outcomes after gout flares, with either medical treatment alone or a combination of both medical and surgical treatment 49,55-60,66 . Overall, CA patients seem to have excellent functional outcomes and pain relief, but more data are needed to support this understanding.…”