Patients With Preexisting Gout at Risk for Recurrence After Total Knee Arthroplasty

Gout recurrence may be more likely following total knee arthroplasty (TKA) in patients with a prior history of gout, according to results of a study published in The Journal of Arthroplasty.

Researchers from Tulane University School of Medicine, Louisiana, New Orleans, evaluated the effect of TKA on gout.

Data were collected from the PearlDiver Mariner database, which contains patient records collected between 2010 and 2020 from approximately 91 million patients in the US.

Patients who had preexisting gout prior to TKA were compared with those without a gout diagnosis prior to TKA. A 1:1 matching approach was used to balance for cohort differences.

A total of 17,463 individuals each with and without gout prior to TKA were included in the study. The gout cohort and control group included participants aged a mean of 67 and 67 years, and 39.6% and 39.6% were women, respectively.

Two years after TKA, 53.8% of the gout group had a recurrence and 3.6% of control group was diagnosed with gout (odds ratio [OR], 30.86; 95% CI, 28.35-33.66).

At 1 year, the groups had similar rates of incision and debridement (2.0%-2.5%), prosthetic loosening (0.9%-1.2%), and periprosthetic fracture (0.4%-0.7%), but the cohort with vs without preexisting gout had higher occurrence of revisions (2.5% vs 1.3%; OR, 2.08; 1.41-3.05) and prosthetic joint infections (5.3% vs 3.3%; OR, 1.81; 1.40-2.33).

However, when the analysis was restricted to patients with gout in their operated knee, those with vs without gout recurrence (n=149 vs 594, respectively) had a higher risk for prosthetic loosening (OR, 10.17; 95% CI, 2.12-72.63), prosthetic joint infection (OR, 5.70; 95% CI, 1.82-19.50), and revision (OR, 4.86; 95% CI, 1.83-13.26) at 1 year.

At 2 years, patients with vs without gout in their operated knee were at increased risk for prosthetic loosening (OR, 5.23; 95% CI, 1.35-21.70), prosthetic joint infection (OR, 6.00; 95% CI, 2.28-16.78), and revision (OR, 4.84; 95% CI, 2.15-11.07).

One of the study limitations was the lack of generalizability for longer-term outcomes.

The study authors concluded, “Appropriate diagnosis and management of patients with a history of gout in the perioperative setting is important for reducing the risk of recurrence of gout postoperatively. Reducing gout attacks after primary TKA may be important to mitigate risks for poor joint outcomes.”