Diagnosis and management of gout in total knee arthroplasty

Gout is a common arthritic condition that continues to increase in prevalence. Symptoms of gout include a rapid onset of pain, erythema, swelling, and warmth in the affected joint. These symptoms may mimic cellulitis, thrombophlebitis, and septic arthritis (); however, a definitive diagnosis can be obtained through joint aspiration and subsequent fluid analysis to assess for the presence of monosodium urate crystals. Gout can also be present after total joint replacement. Because of the similarity of symptoms to septic arthritis, the diagnosis may be missed. Gout may be present in a prosthetic knee or may coexist with septic arthritis. Therefore, analysis of knee aspirations should include cell count, gram stain, cultures, and an examination of the synovial fluid for crystals. The following case study discusses the complex issues involved in treating coexistent gout and infection in a prosthetic knee.