Ochronosis of the knee with secondary osteoarthritis requiring total knee replacement in a patient with cryptogenic organising pneumonia

Jasper, Jorrit; Metsaars, Wieneke P.; Jansen, Joris A.

doi:10.1136/bcr-2016-215412

Cited by 5 publications

(6 citation statements)

References 7 publications

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“…This is the second case described in literature with infection and ochronosis, but there not seems to have any relationship between them. 4 The immunocompromised system and infiltration on the knee must have acted as risk factors for septic arthritis in this case. The joint destruction in these complex patient (with adenocarcinoma, ochronosis arthropathy and septic arthritis) was analysed carefully and it was chosen a non-aggressive management.…”

Section: Discussionmentioning

confidence: 89%

“…Currently, there is no proven therapy or prophylactic treatment for alkaptonuric patients. 2,4 Treatment options are administration of nonsteroidal anti-inflammatory drugs, intake of preparations containing glucosamine and chondroitin sulphate, intra-articular injection of hyaluronic acid and steroids, arthroscopic debridement of the affected joint, and arthroplasty. Treatment is generally supportive and aimed at preventing or minimizing the effects of ochronotic arthropathy, like others arthritis.…”

Section: Discussionmentioning

confidence: 99%

“…1 The diagnosis is often delayed because of its low prevalence and nonspecific early symptoms. 4 The diagnosis occasionally is discovered intraoperatively in patients undergoing joint replacement surgery through the observation of the characteristic bluish-black pigmentation of the tissue surrounding the joint. 2 Ochronotic arthropathy manifests first in the spine.…”

Section: Introductionmentioning

confidence: 99%

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Septic arthritis in ochronosis’ patient

Medeiros¹,

Correia²,

Sousa³

et al. 2019

MOJOR

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Alkaptonuria is a rare autosomal recessive metabolic disease caused by homogentisic acid oxidase enzyme deficiency. High homogentisic acid levels will eventually result in black deposits in skin, sclerae, connective tissues (ochronosis) and urine (alkaptonuria). It can lead to early degeneration of joints. The diagnosis is often delayed because of its low prevalence and non-specific early symptoms. We describe a clinical presentation of ochronotic arthropathy, on a complex patient, who developed a septic arthritis of the knee. The patient was under immunosuppressive therapy, due to a previous colon adenocarcinoma and received a knee corticosteroid infiltration, two weeks before the onset of pain. It was performed joint lavage and arthrolysis by arthrotomy. During the procedure, we found a dark pigmentation on bone. Urine tests were positive for alkaptonuria. The patient completed an antibiotic cycle and rehabilitation, with satisfying improvement in knee's range of motion. At four years follow-up the patient can walk without crutches, presents minor knee pain. High level of suspicion and awareness is needed to diagnose ochronosis. The joint destruction in a complex patient must be carefully analysed. We've chosen a non-aggressive therapeutic management, but according to the literature, other therapeutic strategies could have also been chosen, like joint arthroplasty. We've declined this option because the patient is still doing antineoplastic treatment.

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Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Septic arthritis in ochronosis’ patient

Medeiros¹,

Correia²,

Sousa³

et al. 2019

MOJOR

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“…The decrease in movement is secondary to pain, regional muscles may atrophy, and ligaments may become weaker 4,5 . Most common sites for osteoarthritis are hip (19%), spine, hand, and foot (30%) while majorly affecting knee joint (41%).…”

Section: Introductionmentioning

confidence: 99%

Effects of Open and Closed Chain Exercises on Dynamic Balance and Range of Motion in Patients with Knee Osteoarthritis: RCT

Raza¹,

Hassan²,

Edwin³

et al. 2022

PJMHS

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Background: Osteoarthritis is a combination of mechanical problems characterized by degradation of articular cartilage, articulating joints and subchondral space. Aim: To compare the effects of open chain kinetic exercises and closed kinetic chain exercises in improving dynamic balance and range of motion in patients with knee osteoarthritis. Study Design: Randomized controlled trial. Methodology: Study was conducted at Chugtai Medical center Lahore and sample of 46 patients were recruited and were randomly allocated in two groups. One group performed OKC exercises and the other group was asked to perform CKC exercises, while both of the groups received a common baseline treatment prior to corresponding intervention. Two session a week were given for a period of one month. Goniometry and Y-balance scale were used to assess ROM and dynamic balance pre and post treatment, respectively. Data was evaluated by using SPSS version 23. Results: In this study, the intra-group analysis illustrated that the increase in range of motion and improvement in dynamic balance was statistically significant in both groups with p-value<0.05. Whereas, the inter-group analysis showed that both interventions were clinically effective in treating knee osteoarthritis with p-value>0.05 during the treatment session of four weeks. Practical Implication: This study highlighted that physical training that includes open kinetic chain (OKC) and closed kinetic chain (CKC) exercises were found to be effective in improving balance and in increasing range of motion by reducing pain among osteoarthritis patients. Conclusion: It was concluded that patients with OKC exercises have shown equal improvement in ROM and dynamic balance compared to those who have been treated with CKC exercises. Keywords: Osteoarthritis, Exercises and Dynamic Balance.

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“…Systemic metabolic diseases cause diminution in bone density, and only limited cases of ochronotic arthropathy can be found in the medical literature because of the rarity of the disease [6][7][8][9]. This report presents the case of a man with bilateral hip and knee ochronotic arthropathy who underwent arthroplasty for all affected joints with a long-term follow-up of 12 years.…”

Section: Introductionmentioning

confidence: 99%

Long-term follow-up of bilateral hip and knee arthroplasty secondary to ochronotic arthropathy

et al. 2020

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Alkaptonuria is a rare metabolic disorder caused by the deficiency of homogentisic acid oxidase enzyme, which is responsible for eliminating homogentisic acid from the body through the renal system. Excessive accumulation of homogentisic acid leads to ochronosis and ochronotic arthritis. Owing to the rarity of the disease, long-term functional outcomes of joint replacements of the hips and knees in ochronosis arthropathy are unconfirmed, and only a limited number of case reports are available on this. We present a case of a 45-year-old man with ochronosis and advanced osteoarthritis of both the hips and knees. He underwent bilateral hip and knee replacements as staged procedures. At a follow-up of more than 12 years, the man had full mobility with no loosening of implants.

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Ochronosis of the knee with secondary osteoarthritis requiring total knee replacement in a patient with cryptogenic organising pneumonia

Cited by 5 publications

References 7 publications

Septic arthritis in ochronosis’ patient

Septic arthritis in ochronosis’ patient

Effects of Open and Closed Chain Exercises on Dynamic Balance and Range of Motion in Patients with Knee Osteoarthritis: RCT

Long-term follow-up of bilateral hip and knee arthroplasty secondary to ochronotic arthropathy

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