Acute Gout Attack Immediately After Total Knee Arthroplasty: A Case Report.

Area of Science:

• Orthopedic Surgery
• Rheumatology
• Crystal-Induced Arthritis

Background:

• Distinguishing between infection and crystal-induced arthritis post-total knee arthroplasty (TKA) is clinically challenging.
• Acute inflammation markers in laboratory tests may not reliably differentiate between these conditions.
• Gouty arthritis is a common crystal-induced arthropathy, while periprosthetic joint infection is a serious complication after TKA.

Observation:

• A 73-year-old male presented with symptoms mimicking infection immediately following right TKA.
• Repetitive laboratory tests indicated acute inflammation but were inconclusive for differentiating gout from bacterial infection.
• Surgical exploration revealed chalky white crystals, characteristic of gout, in both knees, with no signs of bacterial infection.

Findings:

• The patient's presentation post-TKA was ultimately diagnosed as acute gouty arthritis, not infection.
• Surgical intervention, including irrigation and debridement, was performed for both diagnostic and therapeutic purposes.
• The presence of gout crystals confirmed the diagnosis despite initial inflammatory signs.

Implications:

• This case highlights the importance of considering crystal-induced arthritis in the differential diagnosis of acute inflammatory conditions after TKA.
• Early surgical intervention, including diagnostic arthroscopy and debridement, can be beneficial for managing gout in prosthetic joints.
• Prompt diagnosis and appropriate treatment are crucial for optimizing clinical outcomes and preventing complications in patients with prosthetic joints.