Acute crystal arthritis mimicking infection after total knee arthroplasty

doi:10.1136/bmj.331.7528.1322

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G Holt (graemeholt@btinternet.com), specialist registrar1,
C Vass, senior house officer1,
C S Kumar, consultant1

¹Department of Orthopaedic and Trauma Surgery, Glasgow Royal Infirmary, Glasgow G4 0SF

Correspondence to: G Holt

Accepted 29 April 2005

Introduction

Total knee arthroplasty is the most effective treatment to relieve the pain associated with end stage arthritis of the knee.1 A reported 0.5-2% of people will develop sepsis of the implant, necessitating lavage and debridement of the affected knee with immediate or delayed removal of the implant.2 3 The key to successful management of implant sepsis is early and accurate diagnosis, which allows prompt treatment. Every patient with pain and swelling at the site of a total knee arthroplasty must, therefore, be assessed for infection.1 We report a case of a patient initially diagnosed as having implant sepsis who in fact had pseudogout of the knee. This shows the diagnostic difficulties and issues surrounding management that may arise when a patient presents with crystal arthritis at the site of previous joint replacement.

Case report

A previously well 72 year old man presented with a three day history of progressive swelling of the left knee with associated pain, erythema of the skin, tachycardia, and a fever of 38.8°C. Two years before, the patient had had primary total knee arthroplasty surgery of the affected joint for a …