Phillips David S, Workman Kalain K, Kelly Matthew
Department of Orthopaedic Surgery, University of Pittsburgh Medical Center Pinnacle, Harrisburg, PA, USA.
Arthroplast Today. 2021 May 15;9:65-67. doi: 10.1016/j.artd.2021.04.007. eCollection 2021 Jun.
Gout is a rare cause of pain after total knee arthroplasty, and its presentation can be difficult to distinguish from a prosthetic joint infection. We describe a patient with left knee pain that had a history of gout and left total knee arthroplasty. Synovial fluid demonstrated monosodium urate crystals and positive alpha-defensin assay. Surgery was not pursued given a low clinical suspicion for infection and negative cultures. Her symptoms improved and ultimately resolved. There are limited case reports of periprosthetic aseptic gout flare, and only one case of concomitant positive alpha-defensin assay and monosodium urate crystals in a patient treated surgically. This case raises the possibility that patients with periprosthetic crystal arthropathy and a positive alpha-defensin test can be managed nonoperatively in the appropriate setting.
痛风是全膝关节置换术后疼痛的罕见原因，其表现可能难以与人工关节感染相区分。我们描述了一名有痛风病史且接受过左膝全膝关节置换术的左膝疼痛患者。滑液显示有尿酸钠结晶且α-防御素检测呈阳性。鉴于临床对感染的怀疑较低且培养结果为阴性，未进行手术。她的症状有所改善并最终消失。关于假体周围无菌性痛风发作的病例报告有限，且仅有一例在接受手术治疗的患者中同时出现α-防御素检测呈阳性和尿酸钠结晶。该病例提示，在适当情况下，假体周围晶体性关节病且α-防御素检测呈阳性的患者可以采取非手术治疗。
