Early Shaver Surgical Treatment of the Chronic Tophaceous Masses Effectively Remove the Lesions Without Major Complication

Abstract

Background: Gout is a modern-day chronic disease seen in 4·62% of Taiwan’s general population. Although the current treatment of urate lowering therapy (ULT) is effective, there remains 10% of patients who do not response well for this treatment. This paper reviews the effectiveness of the shaver technique, which not only increases efficacy when coupled with ULT but can also be used individually to treat the 10% subset that suffer from chronic tophaceous lesions. Method: Using PubMed, all available series of surgery for tophaceous gout were reviewed. Statistical analysis was performed on our surgical outcomes of patients treated by the shaver technique over a sixteen-year (2002 to 2018) period. Finding: The key to shaver technique is early intervention to prevent joint function deterioration. Statistical analysis showed that infection and surgery sites directly correlate to the prognosis of gout patients. Moreover, 6 published surgical articles were identified. All 6 articles were published between 2009 and 2019. The reported outcome of surgical intervention for gout was positive with satisfactory cosmetic outcome and faster recovery period. Interpretation: Although ULT is currently used as the first-line approach to tophaceous gout, we believe the shaver technique should be implemented at the early phase of tophaceous gout lesions, thereby preventing excessive damage in the joints, but also the complication of the shaver technique is minor compared to other available surgical options. Funding: This study was authors’ own work. Declaration of Interests: No conflicts of interests to be disclosed. Ethics Approval Statement: The study was approved by Institutional Review Board at Kaohsiung Medical University.