Gout in primary total knee arthroplasty: Prevalent but not independently associated with complications

Bradley, Alexander T.; King, Connor A.; Cohen-Rosenblum, Anna; Sculco, Peter K.; Landy, David C.

doi:10.1016/j.knee.2020.11.007

Cited by 4 publications

(7 citation statements)

References 38 publications

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“…Interestingly, other studies have reported that CAs are not associated with perioperative TKA complications. One study of more than 64,000 patients with gout found that, after controlling for patient-specific confounders, gout was not associated with the development of PJI or an increased rate of revision after TKA 3 . The authors concluded that, while gout was initially associated with increased complications in their study, this association disappeared after controlling for confounders 3 .…”

Section: Treatment Of Gout Cppd Disease and Pji And Associated Outcomesmentioning

confidence: 99%

“…Owing to the similar presentations of PJI and CA, patients may receive unnecessary surgical treatment for presumed PJI 3 . The current recommended surgical treatments for PJI include debridement, antibiotics, and implant retention (DAIR) and 1-stage or 2-stage revision arthroplasty 69 .…”

Section: Treatment Of Gout Cppd Disease and Pji And Associated Outcomesmentioning

confidence: 99%

“…The prevalence of CA in the context of total knee arthroplasty (TKA) remains largely underestimated because of its subtle and challenging clinical presentation 2 . However, emerging evi-dence suggests that its occurrence is not an uncommon phenomenon, with the prevalence of gout ranging between ,1% and 6.8% [3][4][5][6][7][8] , depending on the population studied. As the number of TKAs performed continues to rise worldwide 9 , it becomes imperative to gain a comprehensive understanding of the association between CA and TKA to optimize patient outcomes and ensure long-term joint function 10,11 .…”

mentioning

confidence: 99%

“…Timely diagnosis is crucial because the treatment approaches for these conditions are drastically different. Misdiagnosis or delayed diagnosis of CA in the setting of TKA can lead to inappropriate management such as unnecessary surgical intervention 2 , resulting in increased financial and resource burden to the hospital and patient, along with the increased risk of infection after a second operation 3 . Therefore, this critical analysis review aims to comprehensively summarize and evaluate existing literature on CA in the context of TKA elucidating (1) risk factors; (2) diagnostic approaches; and (3) treatment management strategies.…”

mentioning

confidence: 99%

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

Huffman,

Pasqualini,

Surace

et al. 2023

JBJS Reviews

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» Emerging evidence suggests the prevalence of crystalline arthropathy (CA) in the setting of total knee arthroplasty (TKA) is increasing, and diagnosis of CA is often intricate because of symptom overlap with other common postoperative complications such as periprosthetic joint infection (PJI). Consequently, an accurate and timely diagnosis becomes pivotal in guiding the choice of treatment.» CA includes gout and calcium pyrophosphate deposition (CPPD) disease, and accurate diagnosis in patients with prior TKA requires a multifaceted approach. The diagnosis algorithm plays a critical role in determining the appropriate treatment approach.» Management of CA typically involves a conservative strategy, encompassing the administration of nonsteroidal anti-inflammatory drugs, colchicine, and steroids, regardless of whether patients have undergone prior TKA.» There is conflicting evidence on the effect CA has on the surgical outcomes in postoperative TKA patients. While these patients may expect excellent functional outcomes and pain relief, they may be at a higher risk of complications such as infections, medical complications, and revision procedures.» Additional research is required to fully comprehend the impact of CA on postoperative TKA outcomes and to establish effective strategies for enhancing patient care and optimizing long-term joint function.

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Section: Treatment Of Gout Cppd Disease and Pji And Associated Outcomesmentioning

confidence: 99%

Section: Treatment Of Gout Cppd Disease and Pji And Associated Outcomesmentioning

confidence: 99%

mentioning

confidence: 99%

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confidence: 99%

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

Huffman,

Pasqualini,

Surace

et al. 2023

JBJS Reviews

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“…A 2021 review of Medicare data from over 1 million primary TKA patients found a higher overall gout prevalence of 5.7%, and similarly did not find any difference in PJI or revision, concluding that gout is not an independent risk factor for adverse outcomes after TKA but that surgeons should be aware that patients with gout often have other risk factors such as obesity and renal disease and counsel accordingly. 31…”

Section: Lower Extremitymentioning

confidence: 99%

Orthopaedic Management of Gout

Cohen-Rosenblum¹,

Somogyi²,

Hynes³

et al. 2022

JAAOS Glob Res Rev

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Gout is characterized by the deposition of monosodium urate crystals in patients with chronically elevated blood levels of uric acid. It is the most common form of inflammatory arthritis in the United States and is often comorbid with hypertension, obesity, and chronic kidney disease. Initial presentation is usually an acutely warm, swollen joint, most commonly the first metatarsophalangeal joint, but a variety of locations may be affected. The main treatment for gout is medical management of acute inflammation and chronic uric acid levels, but surgical treatment may be indicated in cases of damage to the surrounding soft tissue, concomitant septic arthritis, symptomatic cartilage loss, or neurologic deficits. Based on the literature to date, gout does not seem to independently affect outcomes after total hip, knee, and ankle arthroplasty, but associated comorbidities affecting outcomes in these patients should be considered.

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Crohn’s disease is associated with higher rates of implant-related complications following primary total knee arthroplasty

Pandya,

Ganesan,

Rodriguez

et al. 2023

Eur J Orthop Surg Traumatol

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Gout in primary total knee arthroplasty: Prevalent but not independently associated with complications

Cited by 4 publications

References 38 publications

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

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

Orthopaedic Management of Gout

Crohn’s disease is associated with higher rates of implant-related complications following primary total knee arthroplasty

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