Lamprecht Chris, Turnbull Lacie, Barnett Alex, Nasri Elham, Wang Miqi
University of Florida College of Medicine , Gainesville, USA.
Department of Pathology, Immunology and Laboratory Medicine, Gainesville, USA.
Arch Orthop Trauma Surg. 2025 Jun 16;145(1):345. doi: 10.1007/s00402-025-05945-2.
Pseudogout is characterized by the deposition of calcium pyrophosphate crystals in the pericellular matrix of chondrocytes. Pseudogout flares can present similar to gout, osteoarthritis, septic arthritis, or prosthetic joint infection, potentially complicating post-surgical outcomes. With a high prevalence among patients undergoing arthroplasty, appropriate awareness is essential to mitigate misdiagnosis and inappropriate treatment. This study reviews a series of eight patients in whom white deposits are identified intraoperatively and seeks to guide identification, patient education, and future treatment for pseudogout.
Patients undergoing surgical intervention were assessed for the presence of an intraarticular white substance. When the substance was identified, a sample was sent for assessment by a pathologist. The patients' age, sex, pertinent history, surgery, site of biopsy, and pathologist findings were documented.
Of the eight patients included in the study, the average age was 67.9 years (range 62-75). Five (62.5%) were male and three (37.5%) were female. Six (75%) were found to have CPPD crystals. Out of these six, one had a steroid injection 5 months prior and another 7 months prior. One patient who had a steroid injection 4 months prior to surgery had a scant amount of white substance that was identified as "acellular material" by the pathologist. Only a single patient of these six had a standing diagnosis of pseudogout prior to surgery. Intraoperatively, the white substances were visually similar in all cases.
There is a high prevalence of pseudogout in patients over the age of 65 and with concurrent arthritis. Presentation of pseudogout can range from asymptomatic to mimicking septic arthritis. Unidentified white substances noted intraoperatively should be sent to pathology for identification. In patients with pseudogout, it is important to educate the patient and consider prophylactic treatment to minimize risk of recurrence and damage to other joints.
假性痛风的特征是焦磷酸钙晶体沉积在软骨细胞的细胞周基质中。假性痛风发作的表现可能类似于痛风、骨关节炎、化脓性关节炎或人工关节感染，这可能会使手术预后复杂化。在接受关节置换术的患者中，假性痛风的患病率很高，因此提高认识对于减少误诊和不恰当治疗至关重要。本研究回顾了一系列8例术中发现白色沉积物的患者，并试图为假性痛风的识别、患者教育和未来治疗提供指导。
对接受手术干预的患者进行关节内白色物质的评估。当发现该物质时，将样本送检病理学家进行评估。记录患者的年龄、性别、相关病史、手术情况、活检部位和病理学家的检查结果。
纳入研究的8例患者中，平均年龄为67.9岁（范围62 - 75岁）。5例（62.5%）为男性，3例（37.5%）为女性。6例（75%）发现有焦磷酸钙双水化物（CPPD）晶体。在这6例中，1例在术前5个月接受过类固醇注射，另1例在术前7个月接受过类固醇注射。1例在手术前4个月接受过类固醇注射的患者，有少量白色物质，病理学家将其鉴定为“无细胞物质”。这6例中只有1例在手术前有明确的假性痛风诊断。术中，所有病例的白色物质在外观上相似。
65岁以上并发关节炎的患者中假性痛风的患病率很高。假性痛风的表现范围从无症状到类似化脓性关节炎。术中发现的不明白色物质应送检病理以进行鉴定。对于患有假性痛风的患者，对患者进行教育并考虑预防性治疗以将复发风险和对其他关节的损害降至最低非常重要。
