Feixu Pan1, Qi Li, Xin Tang, Jing Xue, Jian Li. 1. Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu Sichuan 610041, PR China.
Abstract
OBJECTIVE: To investigate the method and the effectiveness of a combination of the arthroscopic debridement and joint irrigation postoperatively for treating gouty arthritis of the knee. METHODS: Between August 2000 and November 2009, 41 patients with gouty arthritis of the knee were treated by arthroscopic debridement. All patients were males with an average age of 42 years (range, 21-71 years), including 8 incipient cases and 33 relapsed cases. The unilateral knees were involved in 36 cases, including 22 left knees and 14 right knees, and both in 5 cases. The disease duration ranged from 2 months to 20 years (median, 6 years and 2 months). The extension, flexion, and range of motion (ROM) of the knee joint were (4.88 +/- 6.22), (93.95 +/- 35.33), and (87.79 +/- 35.19) degrees, respectively, and Lysholm score was 63.2 +/- 11.7 preoperatively. The serum uric acid levels were higher than normal value in 32 cases. Twenty-seven cases were definitely diagnosed as gouty arthritis before operation. Arthroscopic debridement was performed in 11 cases, and the arthroscopic debridement with joint irrigation postoperatively in 30 cases. After operation, the anti-gout agents and diet control were given. RESULTS: Arthroscope and pathologic examinations confirmed diagnosis of gouty arthritis in 41 patients. Intra-articular hemorrhage occurred in 1 case and was cured after arthroscopic evacuation of hematoma. The other patients achieved healing of incision by first intention. All 41 patients were followed up 15-126 months (mean, 50 months) postoperatively. The Lysholm score was 96.8 +/- 5.8 at 15 months after operation, showing significant difference when compared with the preoperative value (t = 13.844, P = 0.000). The postoperative extension (1.16 +/- 3.91) degrees, flexion (125.93 +/- 18.65) degrees, and ROM (126.86 +/- 16.33) degrees of the knee joint were significantly improved when compared with the preoperative ones (P < 0.05). Thirteen cases (14 knees) recurred postoperatively; but occurrence frequency and the duration were decreased and the symptoms of joint swelling and pain were improved. CONCLUSION: The arthroscopic debridement is effective in cleaning up uric acid crystals thoroughly, reducing wounds, and speeding up recovery. If anti-gout agents and diet control can be used postoperatively, the recurrence of gouty arthritis can be prevented effectively, and the progression can be delayed.
OBJECTIVE: To investigate the method and the effectiveness of a combination of the arthroscopic debridement and joint irrigation postoperatively for treating gouty arthritis of the knee. METHODS: Between August 2000 and November 2009, 41 patients with gouty arthritis of the knee were treated by arthroscopic debridement. All patients were males with an average age of 42 years (range, 21-71 years), including 8 incipient cases and 33 relapsed cases. The unilateral knees were involved in 36 cases, including 22 left knees and 14 right knees, and both in 5 cases. The disease duration ranged from 2 months to 20 years (median, 6 years and 2 months). The extension, flexion, and range of motion (ROM) of the knee joint were (4.88 +/- 6.22), (93.95 +/- 35.33), and (87.79 +/- 35.19) degrees, respectively, and Lysholm score was 63.2 +/- 11.7 preoperatively. The serum uric acid levels were higher than normal value in 32 cases. Twenty-seven cases were definitely diagnosed as gouty arthritis before operation. Arthroscopic debridement was performed in 11 cases, and the arthroscopic debridement with joint irrigation postoperatively in 30 cases. After operation, the anti-gout agents and diet control were given. RESULTS: Arthroscope and pathologic examinations confirmed diagnosis of gouty arthritis in 41 patients. Intra-articular hemorrhage occurred in 1 case and was cured after arthroscopic evacuation of hematoma. The other patients achieved healing of incision by first intention. All 41 patients were followed up 15-126 months (mean, 50 months) postoperatively. The Lysholm score was 96.8 +/- 5.8 at 15 months after operation, showing significant difference when compared with the preoperative value (t = 13.844, P = 0.000). The postoperative extension (1.16 +/- 3.91) degrees, flexion (125.93 +/- 18.65) degrees, and ROM (126.86 +/- 16.33) degrees of the knee joint were significantly improved when compared with the preoperative ones (P < 0.05). Thirteen cases (14 knees) recurred postoperatively; but occurrence frequency and the duration were decreased and the symptoms of joint swelling and pain were improved. CONCLUSION: The arthroscopic debridement is effective in cleaning up uric acid crystals thoroughly, reducing wounds, and speeding up recovery. If anti-gout agents and diet control can be used postoperatively, the recurrence of gouty arthritis can be prevented effectively, and the progression can be delayed.