J Bone Jt Infect 2019; 4(1):20-26. doi:10.7150/jbji.29983

Research Paper

Clinical Presentation, Management, and Prognosis of Pseudogout in Joint Arthroplasty: A Retrospective Cohort Study

Merit P. George1, Floranne C. Ernste2, Aaron Tande3, Douglas Osmon3, Tad Mabry4, Elie F. Berbari3✉

1. Mayo Clinic School of Medicine. 200 1st St SW, Rochester, MN 55905.
2. Division of Rheumatology, Department of Internal Medicine, Mayo Clinic School of Graduate Medical Education. 200 1st St SW, Rochester, MN 55905.
3. Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic School of Graduate Medical Education. 200 1st St SW, Rochester, MN 55905.
4. Division of Orthopedic Surgery, Department of Surgery, Mayo Clinic School of Graduate Medical Education. 200 1st St SW, Rochester, MN 55905

Abstract

Introduction: Calcium pyrophosphate deposition disease (CPPD), or pseudogout, is rare in prosthetic joints, but can mimic prosthetic joint infection (PJI) according to case reports. The purpose of this case series is to describe the demographics, presentation, management, and outcomes of a cohort of these patients seen at our academic medical center.

Methods: Patients with post-implant pseudogout, who were evaluated at our medical center between January 1, 2000 and June 30, 2016, were identified from our EHR. Data pertaining to demographics, presentation, management, and outcomes were abstracted, and patients were categorized into two groups based on presence of concomitant infection along with positive CPDD findings in synovial fluid.

Results: 22 patients were included. 90.9% of cases involved a TKA. The most common indication for arthroplasty was degenerative joint disease. Only four patients had a history of previous gout or pseudogout, three of which belonged to the group with no evidence of concomitant joint infection. Clinical features for patients without concomitant infection included pain (100%), swelling at the joint (88.9%), redness (33.3%), fever (22.2%), and decreased range of motion (100%). 45.5% of patients received antibiotics prior to joint aspiration (44.4% of patients with negative synovial fluid cultures, 46.2% of patients with concomitant infection).

Conclusion: Our study suggests similar clinical presentation between post-implant pseudogout and PJI. Among patients with pseudogout as well as in those with PJI, the first dose of antibiotics should not be given before sampling for synovial culture. Unfortunately, many patients receive antibiotics prior to culture ascertainment, which raises concern for antibiotic overuse.

Keywords: pseudogout, prosthetic infection, arthroplasty

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How to cite this article:
George MP, Ernste FC, Tande A, Osmon D, Mabry T, Berbari EF. Clinical Presentation, Management, and Prognosis of Pseudogout in Joint Arthroplasty: A Retrospective Cohort Study. J Bone Jt Infect 2019; 4(1):20-26. doi:10.7150/jbji.29983. Available from http://www.jbji.net/v04p0020.htm