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.
Highlights
Calcium pyrophosphate deposition disease (CPPD), or pseudogout, is rare in prosthetic joints, but can mimic prosthetic joint infection (PJI) according to case reports
The goal of our study is to describe the demographics, clinical presentation, management, and long-term outcomes of patients with prosthetic joints and pseudogout seen at our tertiary care medical center, using a retrospective cohort study design
We found that majority of our patients with post-implant pseudogout were Caucasian males, with the most commonly affected joint replacement being total knee arthroplasty (TKA) for degenerative joint disease (DJD)
Summary
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. Among all living adults between the age of 80-89, about 6% had a history of total hip replacement while around 10% have a history of total knee replacement [1]. Data from the Nationwide Inpatient Sample suggests that the annual incidence rate of PJI in the United States rose from 1.99 to 2.18% of all hip arthroplasties and 2.05 to http://www.jbji.net. The economic impact of the management of these infections is substantial, with a projected net cost of $1.62 billion in 2020 [2]
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