Ye Y L, Liu H, Pan L P, Chai W B
Department of Orthopedics, Peking University First Hospital, Beijing 100034, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2023 Apr 18;55(2):362-365. doi: 10.19723/j.issn.1671-167X.2023.02.024.
Periprosthetic gout flare is a rare arthritic condition after total knee arthroplasty, but the symptoms of gout may have often been mistaken as acute periprosthetic infection given their similarity. Misdiagnosis as periprosthetic infection can lead to unnecessary surgery, long-term dependence on anti-biotics, and even malfunction of the involved knee joint. Here, we report a case study of a patient with immunodeficiency condition of long-term oral glucocorticoid and diabetes mellitus, who had undergone a knee replacement 8 weeks before. The initial symptoms of fever and joint pain together with the dysfunction of her right knee with elevated inflammatory markers, such as increased serum leukocytes, erythrocyte sedimentation rate, C-reactive protein, and synovial cell counts led to a diagnosis of acute periprosthetic infection. Arthrocentesis and bacterial culture were performed preoperatively. According to the current Musculoskeletal Infection Society (MSIS) criteria for diagnosis of periprosthetic infection, the case was classified as periprosthetic infection and a prosthesis retained debridement surgery was performed. However we got negative culture results in all the pre-operative and intro-operative samples. The symptoms as well as the laboratory inflammatory markers improved shortly after the debridement surgery until the 11th day when all the similar systemic and local symptoms recurred. With a remedial crystal analysis of synovial fluid from the patient, gouty flare was found to be the cause of acute arthritis finally. Accor-dingly, after anti-gout medications were administrated, the symptoms associated with acute arthritis gra- dually subsided, and there was no recurrence during a 24-month follow-up. This article described the cli-nical manifestation, diagnosis and differential diagnosis, treatment of a case of periprosthetic gout. Although relatively rare, gout should be considered as a differential diagnosis in suspected periprosthetic infection. Current criteria for periprosthetic infection can not exclude the diagnosis of periprosthetic gout flare, it is therefore imperative that the analysis of joint aspirate for crystals be conducted to determine the correct course of treatment, or unnecessary surgical procedure may be performed in periprosthetic gout case.
人工关节周围痛风发作是全膝关节置换术后一种罕见的关节炎病症，但鉴于痛风症状与急性人工关节周围感染相似，其症状常被误诊为急性人工关节周围感染。误诊为人工关节周围感染会导致不必要的手术、长期依赖抗生素，甚至受累膝关节功能障碍。在此，我们报告一例长期口服糖皮质激素且患有糖尿病的免疫缺陷患者的病例研究，该患者在8周前接受了膝关节置换手术。发热和关节疼痛的初始症状，以及右膝关节功能障碍和炎症指标升高，如血清白细胞、红细胞沉降率、C反应蛋白和滑膜细胞计数增加，导致诊断为急性人工关节周围感染。术前进行了关节穿刺和细菌培养。根据当前肌肉骨骼感染学会（MSIS）关于人工关节周围感染的诊断标准，该病例被归类为人工关节周围感染，并进行了保留假体的清创手术。然而，我们在所有术前和术中样本的培养结果均为阴性。清创手术后，症状以及实验室炎症指标在术后不久有所改善，直到第11天，所有类似的全身和局部症状再次出现。通过对患者滑膜液进行补救性晶体分析，最终发现痛风发作是急性关节炎的病因。因此，在给予抗痛风药物治疗后，与急性关节炎相关的症状逐渐消退，并且在24个月的随访期间未复发。本文描述了一例人工关节周围痛风的临床表现、诊断与鉴别诊断及治疗。尽管相对罕见，但在疑似人工关节周围感染时应考虑痛风作为鉴别诊断。目前人工关节周围感染的诊断标准不能排除人工关节周围痛风发作的诊断，因此必须对关节穿刺液进行晶体分析以确定正确的治疗方案，否则在人工关节周围痛风病例中可能会进行不必要的手术。
