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Crystal-induced arthritis in prosthetic joints often mimics prosthetic joint infection, often leading to unnecessary treatments. But, early diagnosis and appropriate intervention can prevent risks and shorten hospital stays.
In a systematic review of 44 cases spanning from 1984 to 2021, researchers have uncovered crucial insights into arthritis from crystal formation in prosthetic joints, a condition that can easily be mistaken for a prosthetic joint infection. The goal was to thoroughly analyze the literature to characterize cases of crystal-aroused arthritis in prosthetic joints. An extensive literature search was carried out across several databases, including Web of Science, Cumulative Index to Nursing & Allied Health, Embase, Google Scholar, and PubMed/MEDLINE in adults suffering from arthritis caused by crystal deposition in prosthetic joints.
The review focused on English-language case reports and series, and the selected articles were used for qualitative data synthesis. The findings revealed that crystal-induced arthritis primarily targets patients with knee replacements, typically presenting as acute, monoarticular arthritis. Interestingly, many cases involve patients with bilateral knee replacements, where gout or calcium pyrophosphate deposition disease flares simultaneously in both knees. This highlights the importance of recognizing crystal-induced arthritis as a differential diagnosis for joint pain in prosthetic joints.
Those with crystal-associated joint inflammation in prosthetic joints typically exhibit elevated white blood cell counts, with a predominance of neutrophils. These patients generally respond well to anti-inflammatory therapies, with improvement usually occurring within 1 week. One of the critical challenges identified in the review is the difficulty in distinguishing crystal-induced arthritis from prosthetic joint infections, leading to unnecessary interventions in some cases. Approximately one-third of patients underwent surgical procedures, and 35% received antibiotics.
This study not only deepens the understanding of the diagnosis and management of crystal-induced arthritis (gout, calcium pyrophosphate deposition disease) in prosthetic joints but also emphasizes the need for heightened clinical awareness to avoid misdiagnosis and ensure timely, effective management. By raising awareness of this often-misunderstood condition, the review paves the way for better outcomes in the care of patients with prosthetic joint pain.
BMC Rheumatology
Crystal-induced arthritis in prosthetic joints: a systematic review of clinical features, diagnosis, management, and outcomes
Haruki Sawada et al.
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