Crystal Arthropathy following Knee Arthroplasty: A Review of the Literature

Khalfaoui, Mahdi Yacine; Yassa, Rafik

doi:10.17554/j.issn.2311-5106.2015.02.113

Cited by 5 publications

(5 citation statements)

References 33 publications

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“…While standard cul-ture techniques were utilized by all participating laboratories, the duration of extended culture was not standardized and may have resulted in the reduced sensitivity of pathogen detection. In contrast to previously studied CN cohorts (Choi et al, 2013;Kim et al, 2015), late acute PJI was found to be the predominant infection type; while heterogenous infection type definitions may have contributed to this (Tsukayama et al, 1996), crystal arthropathy as a mimicker of bacterial PJI may provide an alternate explanation for this finding (Khalfaoui and Yassa, 2015).…”

Section: Discussioncontrasting

confidence: 99%

Characteristics and outcomes of culture-negative prosthetic joint infections from the Prosthetic Joint Infection in Australia and New Zealand Observational (PIANO) cohort study

Browning

Manning²,

Metcalf³

et al. 2022

J. Bone Joint Infect.

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Abstract. Introduction: Culture-negative (CN) prosthetic joint infections (PJIs) account for approximately 10 % of all PJIs and present significant challenges for clinicians. We aimed to explore the significance of CN PJIs within a large prospective cohort study, comparing their characteristics and outcomes with culture-positive (CP) cases. Methods: The Prosthetic joint Infection in Australia and New Zealand Observational (PIANO) study is a prospective, multicentre observational cohort study that was conducted at 27 hospitals between 2014 and 2017. We compared baseline characteristics and outcomes of all patients with CN PJI from the PIANO cohort with those of CP cases. We report on PJI diagnostic criteria in the CN cohort and apply internationally recognized PJI diagnostic guidelines to determine optimal CN PJI detection methods. Results: Of the 650 patients with 24-month outcome data available, 55 (8.5 %) were CN and 595 were CP. Compared with the CP cohort, CN patients were more likely to be female (32 (58.2 %) vs. 245 (41.2 %); p = 0.016), involve the shoulder joint (5 (9.1 %) vs. 16 (2.7 %); p = 0.026), and have a lower mean C-reactive protein (142 mg L−1 vs. 187 mg L−1; p = 0.016). Overall, outcomes were superior in CN patients, with culture negativity an independent predictor of treatment success at 24 months (adjusted odds ratio, aOR, of 3.78 and 95 %CI of 1.65–8.67). Suboptimal diagnostic sampling was common in both cohorts, with CN PJI case detection enhanced using the Infectious Diseases Society of America PJI diagnostic guidelines. Conclusions: Current PJI diagnostic guidelines vary substantially in their ability to detect CN PJI, with comprehensive diagnostic sampling necessary to achieve diagnostic certainty. Definitive surgical management strategies should be determined by careful assessment of infection type, rather than by culture status alone.

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Section: Discussioncontrasting

confidence: 99%

Characteristics and outcomes of culture-negative prosthetic joint infections from the Prosthetic Joint Infection in Australia and New Zealand Observational (PIANO) cohort study

Browning

Manning²,

Metcalf³

et al. 2022

J. Bone Joint Infect.

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“…This is in contrast with some of the reported cases, where patients did have significant local discharge or pus 18. There was also some variation in terms of the presence of systemic symptoms like fever or tachycardia, which were relatively minimal in our overall cohort but present in some reported cases in the literature 12,15,18. Taken as a whole, it is evident that the signs and symptoms of post-implant pseudogout can easily be misattributed to those of a PJI due to considerable overlap, encouraging the practitioner to adopt a more aggressive management approach that is recommended for that complication 3.…”

Section: Discussioncontrasting

confidence: 91%

“…It is interesting to note that only four out of nine of our patients without concomitant infection were deliberately started on an anti-inflammatory agent for their pseudogout symptoms. Khalfaoui and Yassa summarized 13 published cases of pseudogout in prosthetic joints 12. Though the presenting symptoms, physical exam findings, negative imaging findings, and aspiration analyses were largely consistent with our findings, the vast majority of the 13 pseudogout patients included in the review were treated conservatively with anti-inflammatory agents.…”

Section: Discussionsupporting

confidence: 82%

“…Khalfaoui and Yassa summarized 13 published cases of pseudogout in prosthetic joints across multiple centers. Although they did not aggregate information regarding gender, mean age for their patients with post-implant pseudogout was 72.1 years [12. Yahia et al provided a descriptive overview of 7 cases of crystal-induced arthritis (any type) after arthroplasty with an age range in years of 67 to 79 10.…”

Section: Discussionmentioning

confidence: 99%

“…Individual case reports have suggested that the initial presenting symptoms of pseudogout in an implanted joint are strikingly similar to those of an acute joint infection, with common complaints of tenderness, pain, swelling, and fever 11,12. Given that the management of these conditions differs significantly, it is important that clinicians have a comprehensive awareness of the specific clinical features, risk factors, and prognosis of both conditions to facilitate earlier diagnosis and management decisions.…”

Section: Introductionmentioning

confidence: 99%

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Clinical Presentation, Management, and Prognosis of Pseudogout in Joint Arthroplasty: A Retrospective Cohort Study

George

Ernste

Tande

et al. 2019

J. Bone Joint Infect.

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Introduction: Calcium pyrophosphate deposition disease (CPPD), or pseudogout, is rare in prosthetic joints, but can mimic prosthetic joint infection (PJI) according to case reports. The purpose of this case series is to describe the demographics, presentation, management, and outcomes of a cohort of these patients seen at our academic medical center.Methods: Patients with post-implant pseudogout, who were evaluated at our medical center between January 1, 2000 and June 30, 2016, were identified from our EHR. Data pertaining to demographics, presentation, management, and outcomes were abstracted, and patients were categorized into two groups based on presence of concomitant infection along with positive CPDD findings in synovial fluid.Results: 22 patients were included. 90.9% of cases involved a TKA. The most common indication for arthroplasty was degenerative joint disease. Only four patients had a history of previous gout or pseudogout, three of which belonged to the group with no evidence of concomitant joint infection. Clinical features for patients without concomitant infection included pain (100%), swelling at the joint (88.9%), redness (33.3%), fever (22.2%), and decreased range of motion (100%). 45.5% of patients received antibiotics prior to joint aspiration (44.4% of patients with negative synovial fluid cultures, 46.2% of patients with concomitant infection).Conclusion: Our study suggests similar clinical presentation between post-implant pseudogout and PJI. Among patients with pseudogout as well as in those with PJI, the first dose of antibiotics should not be given before sampling for synovial culture. Unfortunately, many patients receive antibiotics prior to culture ascertainment, which raises concern for antibiotic overuse.

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Gout in primary total knee arthroplasty: Prevalent but not independently associated with complications

et al. 2021

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Crystal Arthropathy following Knee Arthroplasty: A Review of the Literature

Abstract: intervention. We would advocate the use of routine crystal microscopy in the diagnostic process of all suspected peri-prosthetic infections. A high degree of caution should be taken however in view of the possibility of concomitant prosthetic crystal arthropathy and septic arthritis.

Cited by 5 publications

References 33 publications

Characteristics and outcomes of culture-negative prosthetic joint infections from the Prosthetic Joint Infection in Australia and New Zealand Observational (PIANO) cohort study

Characteristics and outcomes of culture-negative prosthetic joint infections from the Prosthetic Joint Infection in Australia and New Zealand Observational (PIANO) cohort study

Clinical Presentation, Management, and Prognosis of Pseudogout in Joint Arthroplasty: A Retrospective Cohort Study

Gout in primary total knee arthroplasty: Prevalent but not independently associated with complications

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