Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana.
Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia.
J Arthroplasty. 2023 Aug;38(8):1499-1503. doi: 10.1016/j.arth.2023.01.064. Epub 2023 Feb 9.
The prevalence of gout is increasing along with the number of total knee arthroplasties (TKA) performed annually. The purpose of this study was to evaluate the incidence of gout following TKA in patients who had a previous history of gout and to determine if it is associated with an increased rate of postoperative joint complications.
Patients who did and did not have a preoperative diagnosis of gout and underwent a primary TKA were identified from a national database. The gout patients were matched 1:1 to patients who did not have gout and rates of postoperative gout diagnoses within 2 years of surgery were compared. Complication rates at mean 1 and 2 years were then compared for both patient cohorts using multivariable logistic regressions. A total of 17,463 patients with a prior diagnosis of gout were matched with 17,463 controls.
There were 53.8% of patients who had previous gout and had a recurrence of gout within 2 years versus 3.6% of controls (Odds Ratios [OR]: 30.86). At mean 1-year, patients who had gout were significantly more likely to experience prosthetic joint infections (PJIs) and revision procedures. At mean 2 years, gout patients were at increased risk of prosthetic loosening, PJI, revision, and incision and debridement procedures.
This study suggests that patients who had a prior diagnosis of gout are significantly more likely to experience recurrent episodes of gout after TKA. Gout attacks after TKA are associated with an increase in the rate of joint complications.
Level III.
随着每年全膝关节置换术（TKA）数量的增加，痛风的患病率也在增加。本研究旨在评估有痛风既往史的患者在 TKA 后痛风的发生率，并确定其是否与术后关节并发症的发生率增加有关。
从国家数据库中确定了术前诊断为痛风和未诊断为痛风且接受初次 TKA 的患者。将痛风患者与未患痛风的患者 1:1 匹配，并比较术后 2 年内术后痛风诊断的发生率。然后，使用多变量逻辑回归比较两组患者在平均 1 年和 2 年的并发症发生率。共有 17463 例有既往痛风诊断的患者与 17463 例对照匹配。
有 53.8%的患者既往有痛风，在 2 年内痛风复发，而对照组为 3.6%（比值比[OR]：30.86）。在平均 1 年时，有痛风的患者发生假体关节感染（PJI）和翻修手术的可能性明显更高。在平均 2 年时，痛风患者假体松动、PJI、翻修、切开清创手术的风险增加。
本研究表明，有痛风既往史的患者在 TKA 后更有可能出现痛风复发。TKA 后痛风发作与关节并发症发生率增加有关。
III 级。
