Departmeny of Surgery, Isala Hospitals, Zwolle, The Netherlands
Department of Orthopaedic Surgery, Medisch Spectrum Twente, Enschede, The Netherlands.
BMJ Case Rep. 2022 May 6;15(5):e249154. doi: 10.1136/bcr-2022-249154.
A man in his 60s, with a medical history of gout, underwent total knee arthroplasty of his right knee followed by expeditious rehabilitation. Seven months after surgery, he was referred to the emergency ward with sudden onset of pain and swelling of his right knee accompanied with fever. Further inquiry revealed no trauma, infection or skin lesions besides a tongue bite several weeks earlier. An impaired range motion of the knee was seen on physical examination along with a tachycardia. Laboratory studies showed a C reactive protein of 345 mg/L, after which a debridement, antibiotics and implant retention procedure was performed. Intraoperatively obtained synovial fluid showed monosodium urate crystals consistent with crystalline arthropathy (ie, gout). However, unexpectedly, was identified in all microbiological cultures too, confirming a coexistent periprosthetic joint infection. After comprehensive antibiotic treatment and gout flare therapy, this patient made a full recovery with retention of the implant.
一位 60 多岁的男性，有痛风病史，接受了右膝关节全膝关节置换术，随后进行了快速康复。术后 7 个月，他因突发右膝关节疼痛和肿胀并伴有发热而被转至急诊病房。进一步询问除了几周前舌咬伤外，没有外伤、感染或皮肤病变。体格检查发现膝关节活动度受限，心率加快。实验室研究显示 C 反应蛋白为 345mg/L，随后进行了清创术、抗生素治疗和保留植入物手术。术中获得的滑膜液显示单钠尿酸盐晶体，符合结晶性关节炎（即痛风）。然而，出乎意料的是，所有微生物培养物中也都发现了 ，证实合并存在假体周围关节感染。经过全面的抗生素治疗和痛风急性发作治疗后，该患者保留植入物并完全康复。
