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Cohen-Rosenblum AR, Somogyi JR, Hynes KK, Guevara ME. Orthopaedic Management of Gout. J Am Acad Orthop Surg Glob Res Rev 2022; 6:e22.00216. [PMID: 36346841 PMCID: PMC9645791 DOI: 10.5435/jaaosglobal-d-22-00216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 08/14/2022] [Indexed: 10/27/2023]
Abstract
Gout is characterized by the deposition of monosodium urate crystals in patients with chronically elevated blood levels of uric acid. It is the most common form of inflammatory arthritis in the United States and is often comorbid with hypertension, obesity, and chronic kidney disease. Initial presentation is usually an acutely warm, swollen joint, most commonly the first metatarsophalangeal joint, but a variety of locations may be affected. The main treatment for gout is medical management of acute inflammation and chronic uric acid levels, but surgical treatment may be indicated in cases of damage to the surrounding soft tissue, concomitant septic arthritis, symptomatic cartilage loss, or neurologic deficits. Based on the literature to date, gout does not seem to independently affect outcomes after total hip, knee, and ankle arthroplasty, but associated comorbidities affecting outcomes in these patients should be considered.
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Affiliation(s)
- Anna R. Cohen-Rosenblum
- From the Department of Orthopaedic Surgery, Louisiana State University Health Sciences Center, New Orleans, LA (Dr. Cohen-Rosenblum); the Texas Orthopedics; Affiliate Faculty, Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas, Austin, TX (Dr. Somogyi); the Department of Orthopaedic Surgery and Rehabilitation, University of Chicago Medicine, Chicago, IL (Dr. Hynes); and the Department of Medicine, Section of Rheumatology, Louisiana State University Health Sciences Center, New Orleans, LA (Dr. Guevara)
| | - Jason R. Somogyi
- From the Department of Orthopaedic Surgery, Louisiana State University Health Sciences Center, New Orleans, LA (Dr. Cohen-Rosenblum); the Texas Orthopedics; Affiliate Faculty, Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas, Austin, TX (Dr. Somogyi); the Department of Orthopaedic Surgery and Rehabilitation, University of Chicago Medicine, Chicago, IL (Dr. Hynes); and the Department of Medicine, Section of Rheumatology, Louisiana State University Health Sciences Center, New Orleans, LA (Dr. Guevara)
| | - Kelly K. Hynes
- From the Department of Orthopaedic Surgery, Louisiana State University Health Sciences Center, New Orleans, LA (Dr. Cohen-Rosenblum); the Texas Orthopedics; Affiliate Faculty, Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas, Austin, TX (Dr. Somogyi); the Department of Orthopaedic Surgery and Rehabilitation, University of Chicago Medicine, Chicago, IL (Dr. Hynes); and the Department of Medicine, Section of Rheumatology, Louisiana State University Health Sciences Center, New Orleans, LA (Dr. Guevara)
| | - Myriam E. Guevara
- From the Department of Orthopaedic Surgery, Louisiana State University Health Sciences Center, New Orleans, LA (Dr. Cohen-Rosenblum); the Texas Orthopedics; Affiliate Faculty, Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas, Austin, TX (Dr. Somogyi); the Department of Orthopaedic Surgery and Rehabilitation, University of Chicago Medicine, Chicago, IL (Dr. Hynes); and the Department of Medicine, Section of Rheumatology, Louisiana State University Health Sciences Center, New Orleans, LA (Dr. Guevara)
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Elsaman A, El Shereef RR, El Saadany H, Mohamed EF, Ismail F, I Abd Elazeem M, Eid A, Hamdy M, Ali F, El Mallah R, HA Mohammed R, Tharwat S, Senara S, Fawzy S, Gamal RM, Ibrahim HM, Fawzy R, Amer MA, El-Najjar A, Abaza NM, Hammam N, Aboul Fotouh A, Mosaad D. The mounting importance of knee sonographic signs in 425 gouty arthritis patients: A multi-centre study. THE EGYPTIAN RHEUMATOLOGIST 2022; 44:287-293. [DOI: 10.1016/j.ejr.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Parisien RL, Ment A, Shin M, Anand N, Martin EA. Pathologic Hip Fracture by Virtue of a Rare Osseous Manifestation of Gout: A Case Report. JBJS Case Connect 2021; 10:e2000231. [PMID: 32960017 DOI: 10.2106/jbjs.cc.20.00231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 76-year-old woman without a personal or family history of gout presented with complaints of left hip pain after a mechanical fall from her wheelchair. Advanced imaging revealed a nonspecific lesion and nondisplaced fracture of the femoral neck. Intraoperative biopsy from the lesion/fracture demonstrated tophaceous gout. CONCLUSION Fractures resulting from osseous manifestations of the gout are rare with this report describing a hip fracture secondary to tophaceous gout. We emphasize the importance of including this potential etiology in the differential diagnosis of elderly patients presenting with hip pain, with or without a known history of gout.
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Affiliation(s)
- Robert L Parisien
- 1Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania 2Department of Orthopaedic Surgery, Lahey Hospital & Medical Center, Burlington, Massachusetts 3Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania 4Department of Anatomic Pathology, Lahey Hospital & Medical Center, Burlington, Massachusetts 5Department of Orthopaedic Surgery, Brigham & Women's Hospital, Boston, Massachusetts
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Corpus-Zuñiga FM, Muramatsu K, Rayel MF, Tani Y, Seto T. Intra-osseous tophaceous gout of a bipartite patella mimicking aggressive bone tumour. Mod Rheumatol Case Rep 2021; 5:399-403. [PMID: 33492186 DOI: 10.1080/24725625.2020.1861743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This is a very rare case of gouty tophus in the patella of a 31-year-old male, without any medical co-morbidities. The patient initially presented after an injury to left knee but came back months later due to persistence of pain. Surgical decision was made based on imaging findings in computed tomography and magnetic resonance imaging of an intraosseous lesion that has increased in size. The initial diagnosis is that of an aggressive bone tumour. The diagnosis of an intraosseous gout was made intra-operatively upon seeing the characteristics of the lesion, and upon confirmation of the biopsy results. Gout can usually be managed medically with urate lowering drugs and lifestyle change. However, when presented with a tophus that is increasing in size and causing mass effect on the involved bone, surgical management is indicated.
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Affiliation(s)
| | - Keiichi Muramatsu
- Department of Orthopedic Surgery, Nagato General Hospital, Yamaguchi, Japan
| | - Ma Felma Rayel
- Department of Orthopedic Surgery, Nagato General Hospital, Yamaguchi, Japan
| | - Yasuhiro Tani
- Department of Orthopedic Surgery, Nagato General Hospital, Yamaguchi, Japan
| | - Tetsuya Seto
- Department of Orthopedic Surgery, Nagato General Hospital, Yamaguchi, Japan
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