Gout after total knee replacement: a 10-year study in Hong Kong

Abstract

<p>Introduction: Gouty attack after a total knee replacement (TKR) is rare, with only a few cases reported in the literature. This study investigates its occurrence in Hong Kong. Methods: The Clinical Data Analysis and Reporting System (CDARS) was used to identify all patient records in the Hong Kong West Cluster hospitals (7 public hospitals managing about 330 000 patients/year), who had a diagnosis code of “Gout” and a procedure code of “Total knee replacement” from 2012 to 2022. The clinical notes were further screened to identify gouty attacks after TKR. Results: A total of 37 patients with a diagnosis of gout and underwent a TKR from 2012 to 2022 were identified from CDARS. After screening, only three patients had postoperative gouty attack in the same replaced knee, all confirmed with joint urate crystals. All occurred in the early postoperative period (14 days to 11 weeks) and had a known history of gout. Joint total cell counts ranged from 51-4460 × 10^6/L and all cultures were negative. Two patients were treated nonsurgically with symptomatic improvement. One patient had surgical debridement of the tophi over the patellar tendon which was causing clunking. Conclusion: Gout after TKR is rare—we identified three cases from the Hong Kong public healthcare system over a tenyear period, the largest study conducted on gout after TKR. Surgeons should be aware of this condition, especially patients with a history of gout, and differentiate it from prosthetic joint infection, the former which can be successfully treated with non-operative treatment<br></p>