The Effects of Gout Following total Knee Arthroplasty: A Retrospective Analysis

Cole, Matthew W.; Collins, Lacee K.; Wilder, J. Heath; Ross, Bailey J.; Hawkins, Barrett J.; Sherman, William F.

doi:10.1016/j.arth.2023.01.064

Cited by 3 publications

(3 citation statements)

References 20 publications

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“…Patients with gout also had a higher chance of prosthesis loosening, PJI, revision, and incision and debridement procedures at an average of 2 years. 27) Interestingly, in another study on post-total knee arthroplasty outcome, gout was associated with a higher risk of PJI and revision at 1 year, which however was no longer associated with gout after controlling for confounding factors. 28) …”

Section: Discussionmentioning

confidence: 96%

Total Hip Arthroplasty Outcomes in Patients with Gout: A Retrospective Analysis of Matched Large Cohorts

Zhang,

Yang,

et al. 2024

Clin Orthop Surg

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Background Gout is the most prevalent form of inflammatory arthritis in the world. Total hip arthroplasty (THA) has emerged as a widely sought-after and highly effective surgical procedure for advanced hip diseases. However, there is a lack of research on the impact of gout on primary THA outcomes in large cohorts. This study aimed to address this gap by primarily investigating complications following THA in patients with or without gout. Methods Patients with records of gout in the 2 years leading up to their primary THA and who also have at least 2 years of follow-up were identified using a national insurance database and compared to a 5:1 matched control. A total of 32,466 patients with gout and 161,514 patients without gout undergoing THA were identified. Multivariable logistic regression analyses were done for medical complications up to 90 days and surgical complications up to 2 years. In addition, 90-day emergency department (ED) visits and inpatient readmission were also documented. Results Patients with gout demonstrated higher rates of medical complications including deep vein thrombosis, transfusion, acute kidney injury, and urinary tract infection than non-gout patients ( p < 0.001). Gout patients also showed higher rates of pulmonary embolism ( p = 0.017). Increased incidences of surgical complications were identified in gout patients, specifically wound complications and periprosthetic joint infection ( p < 0.001). There was an increased risk of revision for gout patients up to 90 days ( p = 0.003), 1 year ( p = 0.027), and 2 years ( p = 0.039). There was also an increased risk of dislocation for gout patients up to 90 days ( p = 0.022) and 1 year ( p = 0.047), but not at 2 years. No significant difference was observed in aseptic loosening or periprosthetic fracture. Additionally, gout patients also demonstrated a higher likelihood of 90-day ED visits and readmission ( p < 0.001). Conclusions Primary THA in gout patients is associated with increased risks of multiple medical and surgical complications. Our findings provide insights into the planning and expectation of THA for patients with gout. These insights have the potential to benefit the decision-making process for gout patients considering THA.

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Section: Discussionmentioning

confidence: 96%

Total Hip Arthroplasty Outcomes in Patients with Gout: A Retrospective Analysis of Matched Large Cohorts

Zhang,

Yang,

et al. 2024

Clin Orthop Surg

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“…A conclusive diagnosis can be established through joint aspiration and subsequent fluid analysis with cell count, gram stain, cultures, and the presence of needle-shaped urate crystals under polarized light microscopy. Elevations in complete blood count, ESR, and CRP levels can occur in both infection and gout [ 9 , 32 ]. Our patient suffered a postoperative periprosthetic infection following poor wound healing from discharging tophaceous material.…”

Section: Discussionmentioning

confidence: 99%

Advanced Erosive Gouty Arthropathy of the Knee

Buruian,

Angelo,

Seiça

et al. 2024

Cureus

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A 57-year-old male, with chronic bilateral knee pain and a history of poorly controlled hyperuricemia leading to gouty attacks, underwent orthopedic assessment. Radiographic and MRI findings confirmed chronic gouty arthropathy with erosive bony defects, the most significant on the right proximal tibia. Total knee arthroplasty (TKA) was performed without any complications, addressing the bony defect with cement and a semi-constrained prosthesis. However, a gouty attack led to prolonged wound discharge and periprosthetic infection postoperatively, prompting revision surgery with debridement, antibiotics, and implant retention (DAIR). Intraoperative cultures revealed methicillin-sensitive Staphylococcus aureus (MSSA). The treatment included vancomycin and rifampicin. Two years post-surgery, the patient walked pain-free with a knee range of motion of 0-90º. This report highlights the complexity of treating goutrelated knee osteoarthritis, emphasizing early intervention to mitigate risks of extensive surgical procedures and infections.

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“…Similarly, Chen et al found a higher rate of renal complications and poor wound healing in TKA patients with gout compared with those without gout 77 . Moreover, a comprehensive investigation comprising more than 17,000 patients with gout demonstrated that patients with gout were significantly more likely to experience PJI (1.8, 1.4-2.3) and revision procedures (2, 1.4-3) at 1 year after TKA, and significantly more likely to experience prosthetic loosening (1.8, 1.1-2.8), PJI (1.8, 1.4-2.3), and revision procedures (1.9, 1.3-2.7) at 2 years after TKA 78 . Similarly, a comprehensive study involving more than 11,000 patients found that patients with CPPD disease who underwent TKA were more likely to have myocardial infarction (1.1, 1.07-1.2) and require knee reoperation (2.6, 1.5-4.3) when compared with those without CPPD disease who underwent TKA 79 .…”

Section: Treatment Of Gout Cppd Disease and Pji And Associated Outcomesmentioning

confidence: 99%

Diagnosis, Treatment, and Outcomes of Crystalline Arthropathy in the Setting of Total Knee Arthroplasty

Huffman,

Pasqualini,

Surace

et al. 2023

JBJS Reviews

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» Emerging evidence suggests the prevalence of crystalline arthropathy (CA) in the setting of total knee arthroplasty (TKA) is increasing, and diagnosis of CA is often intricate because of symptom overlap with other common postoperative complications such as periprosthetic joint infection (PJI). Consequently, an accurate and timely diagnosis becomes pivotal in guiding the choice of treatment.» CA includes gout and calcium pyrophosphate deposition (CPPD) disease, and accurate diagnosis in patients with prior TKA requires a multifaceted approach. The diagnosis algorithm plays a critical role in determining the appropriate treatment approach.» Management of CA typically involves a conservative strategy, encompassing the administration of nonsteroidal anti-inflammatory drugs, colchicine, and steroids, regardless of whether patients have undergone prior TKA.» There is conflicting evidence on the effect CA has on the surgical outcomes in postoperative TKA patients. While these patients may expect excellent functional outcomes and pain relief, they may be at a higher risk of complications such as infections, medical complications, and revision procedures.» Additional research is required to fully comprehend the impact of CA on postoperative TKA outcomes and to establish effective strategies for enhancing patient care and optimizing long-term joint function.

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The Effects of Gout Following total Knee Arthroplasty: A Retrospective Analysis

Cited by 3 publications

References 20 publications

Total Hip Arthroplasty Outcomes in Patients with Gout: A Retrospective Analysis of Matched Large Cohorts

Total Hip Arthroplasty Outcomes in Patients with Gout: A Retrospective Analysis of Matched Large Cohorts

Advanced Erosive Gouty Arthropathy of the Knee

Diagnosis, Treatment, and Outcomes of Crystalline Arthropathy in the Setting of Total Knee Arthroplasty

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