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. 2022 Nov 8;6(11):e22.00216.
doi: 10.5435/JAAOSGlobal-D-22-00216. eCollection 2022 Nov 1.

Orthopaedic Management of Gout

Anna R Cohen-Rosenblum  1 , Jason R Somogyi, Kelly K Hynes, Myriam E Guevara
Affiliations

Orthopaedic Management of Gout

Anna R Cohen-Rosenblum et al. J Am Acad Orthop Surg Glob Res Rev. .

Abstract

Gout is characterized by the deposition of monosodium urate crystals in patients with chronically elevated blood levels of uric acid. It is the most common form of inflammatory arthritis in the United States and is often comorbid with hypertension, obesity, and chronic kidney disease. Initial presentation is usually an acutely warm, swollen joint, most commonly the first metatarsophalangeal joint, but a variety of locations may be affected. The main treatment for gout is medical management of acute inflammation and chronic uric acid levels, but surgical treatment may be indicated in cases of damage to the surrounding soft tissue, concomitant septic arthritis, symptomatic cartilage loss, or neurologic deficits. Based on the literature to date, gout does not seem to independently affect outcomes after total hip, knee, and ankle arthroplasty, but associated comorbidities affecting outcomes in these patients should be considered.

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Figures

Figure 1
Figure 1
A, Radiographic imaging of gout in the thumb (author's clinical photograph). B, MRI of gout in the thumb (author's clinical photograph).
Figure 2
Figure 2
Gouty tophi surrounding the flexor tendon. A, Clinical appearance of a middle finger with chronic tophi impeding flexor tendon excursion. B, The tip of the finger is to the left. The tophus is seen distending the distal half of the A2 pulley along with A3, C2, and the proximal edge of the A4 pulley. C, After débridement of the tophus and careful maintenance of the A2 and A4 pulleys, the tendons displayed marked improvement in excursion. D, Note improved (but not full) composite flexion postoperatively.
Figure 3
Figure 3
Gouty tophus associated with hallux valgus deformity and painful tophus in the second toe (author’s clinical photograph).
Figure 4
Figure 4
Radiographic imaging of gouty tophus associated with hallux valgus deformity showing joint destruction and medial soft tissue of tophus (author's clinical photograph).
Figure 5
Figure 5
Postoperative radiographic imaging showing removal of tophi, first MTP joint deformity correction, and second PIP joint resection arthroplasty (author's clinical photograph). MTP = metatarsophalangeal, PIP = proximal interphalangeal
Figure 6
Figure 6
Radiograph depicting gouty tophus and deformity of the fourth toe middle phalanx (author's clinical photograph).
See this image and copyright information in PMC

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