Similar Clinical Presentations Found in Prosthetic Joint Infection, CPPD After Joint Implantation

Similar clinical presentations have been observed in post-implant calcium pyrophosphate deposition disease (CPPD) and prosthetic joint infection (PJI), according to retrospective cohort study results published in the Journal of Bone and Joint Infection.

The investigators presented a case series in which they evaluated the demographics, presentation, management, and outcomes of a cohort of patients with post-implant CPPD who were examined at the Mayo Clinic in Rochester, Minnesota, between January 1, 2000 and June 30, 2016. Patients were identified from electronic health records and categorized into groups based on the presence of concomitant infection along with positive CPPD findings in synovial fluid.

A total of 22 participants (15 men and 7 women) were included in the analysis; mean patient age was 71 years. Overall, 90.9% of the cases involved a total knee arthroplasty (TKA); the most common reason for TKA was degenerative joint disease. Only 4 of the 22 patients had a history of prior gout or CPPD, 3 of whom had no evidence of concomitant joint infection.

Clinical characteristics of patients without concomitant infection included pain (100%), swelling at the joint (88.9%), redness (33.3%), fever (22.2%), and decreased range of motion (100%). Prior to joint aspiration, 45.5% of patients received antibiotic therapy, 44.4% of whom exhibited negative synovial fluid cultures and 46.2% experienced concomitant infection.

Conclusive testing with synovial fluid aspiration with crystal and culture analyses are needed prior to the administration of antimicrobial therapy to reliably distinguish between the 2 conditions. Unfortunately, many patients are treated with antibiotics prior to culture ascertainment, which highlights concerns about antibiotic overuse.

Reference

George MP, Ernste FC, Tande A, Osmon D, Mabry T, Berbari EF. Clinical presentation, management, and prognosis of pseudogout in joint arthroplasty: a retrospective cohort study. J Bone Jt Infect. 2019;4(1):20-26.