Gout and Knee Replacements
This is an interesting question. We usually don’t associate gout, a type of arthritis that typically affects the toes, with knee problems. However, there are a few situations that may link gout with knee replacement.
Gout is a form of inflammatory arthritis characterized by sudden intense joint pain. The pain often occurs at night and is so intense it wakes you up. The affected joint is also swollen, warm, and the surrounding skin is red or purple. The inflammation is triggered by the accumulation of uric acid crystals in the joint.
While the majority of cases cause inflammation in the large toe, other joints can be affected as well. For example these crystals may accumulate in the knee joint, or the joints of the hand, wrist, fingers and elbow.
Surgery for gout management
Joint replacement surgery may be needed in rare cases when the uric acid crystals cause too much damage to the joint and medication fails to improve the symptoms. If gout affects the knee joint a knee replacement might likely be necessary. However, doctors try as much as they can to stay away from this procedure and to manage the condition before the damage of the joint becomes too advanced.
Other types of surgery may also be required: for example if the tophi, the chalk-like nodules that occur in gout, don’t shrink enough with medication and cause pain especially in the knee or arms and result in a limited range of motion, or if these nodules become infected, a doctor may recommend surgery to remove them. Again, these surgeries are rare, since most tophi are harmless and painless.
Gout can affect a joint that undergoes surgical replacement. A 2001 research paper indicates two cases of gout-induced arthropathy after total knee replacement. It’s not easy to determine whether a knee has developed gout or if it is an infection, since in both cases one may experience acute joint pain, swelling, redness, as well as fever and feeling sick (malaise). Blood tests will also show in both cases signs of inflammation such as an increased white blood cell count and an increased C reactive protein level (a marker of inflammation commonly tested by doctors). The test that will confirm gout involves locating negatively birefringent needle-shaped crystals in the joint fluid.
Gout or pseudogout?
Pseudogout is a condition similar to gout, as it’s also a form of arthritis characterized by sudden intense pain of one or more joints. As in gout, it is caused by deposits of crystals in the joints; however, these crystals are different. A knee is more likely to be affected by pseudogout than gout, and therefore this condition should also be ruled out by the doctor. In very rare cases the affected joint becomes severely damaged and requires knee or joint replacement. The doctor usually assesses the pros and cons of a knee or joint replacement in a gout patient after a careful review of the medical history, afterwards performing a physical exam, ordering various tests and then assessing the current treatment plan.