Bilateral Acute Calcium Pyrophosphate Crystal Arthritis After Bilateral Total Knee Arthroplasty: A Case Report.

Abstract

Calcium pyrophosphate dihydrate (CPPD) deposition disease is a well-described condition of synovial joints that frequently causes major pain and disability1,2. Acute calcium pyrophosphate (CPP) crystal arthritis, commonly called “pseudogout,” refers to the acute attacks of synovitis clinically resembling acute gouty arthropathy and was initially described nearly fifty years ago1,3. The body’s inflammatory response to the crystalline arthropathy causes painful synovitis, and it may bear all of the clinical hallmarks of septic arthritis. The incidence of the disease increases with age, and CPP crystals are commonly found in the synovial fluid aspirates of osteoarthritic knees before total joint arthroplasty4. Cases of CPPD disease, however, have rarely been reported after total joint arthroplasty5-9. To our knowledge, bilateral attacks of pseudogout after bilateral total knee arthroplasty have never been reported in the English-language literature. The patient was informed that data concerning the case would be submitted for publication, and she provided consent. A fifty-two-year-old woman with a history of insulin-dependent diabetes mellitus and hypertension presented to the emergency department (ED) with a three-day history of acute bilateral knee pain of atraumatic onset. She had undergone bilateral total knee arthroplasty for premature osteoarthritis seven years earlier (Figs. 1-A, 1-B, and 1-C), and she had been free of knee pain since the surgery. She had no history of crystalline arthropathy in any joint. On presentation, she reported pain with weight-bearing as well as decreased knee motion bilaterally. Seven days prior to presentation, she had undergone a dental procedure, which included standard antibiotic prophylaxis with amoxicillin. That evening, she had had an initial sensation of tightness in …