Crystal Arthropathy in the Setting of Total Knee Arthroplast
Total knee arthroplasty (TKA) is an effective treatment option for improving pain and function in patients with end-stage osteoarthritis. One major complication of TKA is periprosthetic joint infection (PJI), which develops in an estimated 1-2% of primary cases and up to 9% in revision cases. These infections portend higher mortality and often require burdensome treatment such as additional surgery and long-term antibiotics. Early diagnosis is crucial for optimal PJI management.

Here presented a case of an 82-year-old female with a history of right total knee arthroplasty 11 years prior. She was admitted after a ground-level fall and developed progressive pain and swelling of her right knee. She had no history of complications with her total knee replacement. Radiographs of the knee and hip were negative for acute fracture, dislocation, or hardware malalignment. Knee aspiration was performed and revealed inflammatory exudate, synovial fluid consistent with crystal arthropathy, and no bacterial growth. She was diagnosed with an acute gout flare, and her symptoms significantly improved with steroids and anti-inflammatory treatment. It is critically important to evaluate and treat PJI when present.

However, it is also important to consider the possibility that crystal arthropathy may be responsible for symptoms representing infection in the setting of a total joint arthroplasty. This should be particularly considered in patients with chronic kidney disease, such as the presented case, given the association shared between renal disease and gout Orthopedic surgeons should be aware of the potential for crystal arthropathy in the setting of total joint arthroplasty and evaluate for crystals before treating a presumed periprosthetic joint infection.