Total Knee Arthroplasty in a Patient with Extensive Subcutaneous and Intra-Articular Tophaceous Gout: A Case Report

¹Metro Heart Institute and Medical Centre, Faridabad, India

²Director, Orthopaedics-Yatharth Hospital, Faridabad, India

*Corresponding Author: Udit Kapoor, Metro Heart Institute and Medical Centre, Faridabad, India, Phone: +91-8527154320, E-mail: [email protected]

Received Date: August 15, 2025

Published Date: October 22, 2025

Citation: Kapoor U, et al. (2025). Total Knee Arthroplasty in a Patient with Extensive Subcutaneous and Intra-Articular Tophaceous Gout: A Case Report. Mathews J Case Rep. 10(4):213.

Copyrights: Kapoor U, et al. © (2025).

ABSTRACT

Total knee arthroplasty (TKA) is a well-established procedure for managing advanced arthritis, including chronic gouty arthritis. While tophaceous gout is a recognized cause of joint destruction, the simultaneous presence of extensive subcutaneous and intra-articular tophi is uncommon and presents unique surgical challenges. Case Presentation: A 63-year-old male presented with a six-year history of bilateral knee pain that was dull, and aggravated by walking with no relieving factors. Clinical examination revealed a fixed flexion deformity of 45° bilaterally, with flexion limited to 90°. The patient underwent successful bilateral TKA; however, several intraoperative difficulties were encountered. Large crystalline deposits were observed in both the articular and periarticular regions upon patellar eversion. These deposits were soft, whitish, cheesy, and gritty. Their extensive presence complicated flexion, patellar eversion, identification of the menisci, full extension, and wound closure. All visible tophi were thoroughly excised and sent for histopathological analysis. Postoperative Course: Postoperatively, the patient developed anaemia, leukocytosis, and renal impairment. Bone marrow aspiration revealed hypercellular marrow with trilineage hematopoiesis and increased reticuloendothelial activity, leading to a diagnosis of hemolytic uremic syndrome (HUS). The patient responded well to supportive care and initiated physiotherapy. At follow-up, he had functional recovery with improved joint motion. Conclusion: This case highlights the complexity of managing advanced tophaceous gout with extensive crystal deposition during TKA. Thorough surgical debridement and vigilant postoperative monitoring are essential for successful outcomes in challenging cases.

Keywords: Gouty Arthritis, Total Knee Arthroplasty, Fixed Flexion Deformity, Tophaceous Gout, Joint Replacement.