Total Knee Arthroplasty for Severe Crystalline-Induced Arthropathy: A Case Report From a Third-Level Hospital

Gout is an inflammatory arthritis caused by monosodium urate crystal deposition, leading to progressive joint destruction and functional impairment. While pharmacologic treatment remains the standard, advanced cases with intra-articular and intraosseous tophi may require surgical intervention. Total knee arthroplasty (TKA) has been reported as a viable option for managing severe tophaceous gout with structural bone defects, improving joint function and pain control when conservative therapy fails. We present the case of a 56-year-old male with a long-standing history of gout and progressive knee pain refractory to medical treatment. Imaging revealed extensive intraosseous tophi with cavitary bone defects, prompting the decision for TKA with bone allograft reconstruction. The patient experienced favorable postoperative recovery, demonstrating significant improvement in joint mobility and function, with no complications observed. This case highlights the role of surgical intervention in the management of advanced tophaceous gout as part of an integrated approach alongside pharmacologic control.