{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T22:49:16Z","timestamp":1772232556869,"version":"3.50.1"},"reference-count":40,"publisher":"Georg Thieme Verlag KG","issue":"06","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Knee Surg"],"published-print":{"date-parts":[[2022,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Distinguishing periprosthetic crystalline arthropathy from periprosthetic joint infection (PJI) remains a diagnostic challenge as both symptom presentation and diagnostic tests overlap. Accurate differentiation is important as treatment plans vary significantly. We sought to systematically review all cases of total knee arthroplasty (TKA) periprosthetic crystalline arthropathy reported in the literature and summarize clinical, diagnostic, and operative findings in the context of guidelines for diagnosing PJI. The goal of this systematic review is to determine the amount of diagnostic overlap and to identify best practices for differentiating between these two diagnoses. MEDLINE and Google Scholar were searched to identify cases of crystalline arthropathy following TKA. Case reports were reviewed for patient characteristics, clinical symptoms, physical exam, laboratory results, and treatment outcomes. These findings were summarized across patients and dichotomized based on current thresholds for diagnosing PJI according to Musculoskeletal Infection Society criteria. Twenty-six articles were identified which included 42 cases of periprosthetic crystalline arthropathy (17 gout, 16 pseudogout, one both, and eight not specified). Of these cases, 25 presented over 1 year after their index arthroplasty and 15 had no prior history of crystalline arthropathy. Only six cases had a superimposed infection based on aspiration or intraoperative cultures. For cases without a culture-positive infection, several diagnostic tests overlap with PJI thresholds: 95% of patients had C-reactive protein greater than 1\u2009mg\/dL, 76% had an erythrocyte sedimentation rate greater than 30\u2009mm\/hour, 91% had a synovial white blood cell greater than 3,000 cells, and 76% had a synovial polymorphonuclear cells percent greater than 80%. Patients without co-infection were managed with non-steroidal anti-inflammatory drugs, colchicine, allopurinol, steroids, or a combination of these treatments and most had complete resolution of symptoms within 1 week. Commonly used markers of PJI fail to reliably distinguish periprosthetic crystalline arthropathy from infection. Though clinical judgement and consideration of the implications of delayed treatment for acute PJI remain paramount, in the setting of synovial crystals, surgeons may wish to consider this alternate etiology as the source of the patient's clinical symptoms.<\/jats:p>","DOI":"10.1055\/s-0040-1716507","type":"journal-article","created":{"date-parts":[[2020,9,17]],"date-time":"2020-09-17T22:51:41Z","timestamp":1600383101000},"page":"668-675","source":"Crossref","is-referenced-by-count":7,"title":["Distinguishing Periprosthetic Crystalline Arthropathy from Infection in Total Knee Arthroplasty: A Systematic Review"],"prefix":"10.1055","volume":"35","author":[{"given":"Alexander T.","family":"Bradley","sequence":"additional","affiliation":[{"name":"Orthopaedic Surgery Department, Department 4B, University of Chicago, Chicago, Illinois"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8108-2401","authenticated-orcid":false,"given":"Connor A.","family":"King","sequence":"additional","affiliation":[{"name":"Orthopaedic Surgery Department, Department 4B, University of Chicago, Chicago, Illinois"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ye","family":"Lin","sequence":"additional","affiliation":[{"name":"University of Chicago Pritzker School of Medicine, Chicago, Illinois"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"Sculco","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Hospital for Special Surgery, New York City, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tessa","family":"Balach","sequence":"additional","affiliation":[{"name":"Orthopaedic Surgery Department, Department 4B, University of Chicago, Chicago, Illinois"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David C.","family":"Landy","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Hospital for Special Surgery, New York City, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2020,9,17]]},"reference":[{"issue":"07","key":"ref1","doi-asserted-by":"crossref","first-page":"943","DOI":"10.1302\/0301-620X.88B7.17150","article-title":"The incidence of deep prosthetic infections in a specialist orthopaedic hospital: a 15-year prospective survey","volume":"88","author":"J E Phillips","year":"2006","journal-title":"J Bone Joint Surg Br"},{"issue":"01","key":"ref2","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1007\/s11999-009-1013-5","article-title":"Prosthetic joint infection risk after TKA in the Medicare population","volume":"468","author":"S M Kurtz","year":"2010","journal-title":"Clin Orthop Relat Res"},{"issue":"02","key":"ref3","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1016\/j.arth.2017.09.041","article-title":"Failure after modern total knee arthroplasty: a prospective study of 18,065 knees","volume":"33","author":"M Pitta","year":"2018","journal-title":"J Arthroplasty"},{"issue":"09","key":"ref4","doi-asserted-by":"crossref","first-page":"1774","DOI":"10.1016\/j.arth.2013.07.024","article-title":"Why are total knee arthroplasties failing today--has anything changed after 10 years?","volume":"29","author":"P F Sharkey","year":"2014","journal-title":"J Arthroplasty"},{"issue":"01","key":"ref5","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1007\/s11999-009-0945-0","article-title":"The epidemiology of revision total knee arthroplasty in the United States","volume":"468","author":"K J Bozic","year":"2010","journal-title":"Clin Orthop Relat Res"},{"issue":"01","key":"ref6","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1016\/j.arth.2015.07.034","article-title":"Projected increase in periprosthetic joint infections secondary to rise in diabetes and obesity","volume":"31","author":"P O'Toole","year":"2016","journal-title":"J Arthroplasty"},{"issue":"17","key":"ref7","doi-asserted-by":"crossref","first-page":"1455","DOI":"10.2106\/JBJS.17.01617","article-title":"Projected volume of primary total joint arthroplasty in the U.S., 2014 to 2030","volume":"100","author":"M Sloan","year":"2018","journal-title":"J Bone Joint Surg Am"},{"issue":"11","key":"ref8","doi-asserted-by":"crossref","first-page":"2992","DOI":"10.1007\/s11999-011-2102-9","article-title":"New definition for periprosthetic joint infection: from the Workgroup of the Musculoskeletal Infection Society","volume":"469","author":"J Parvizi","year":"2011","journal-title":"Clin Orthop Relat Res"},{"issue":"03","key":"ref9","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1016\/j.ocl.2016.03.001","article-title":"Diagnosis of periprosthetic joint infection following hip and knee arthroplasty","volume":"47","author":"J Parvizi","year":"2016","journal-title":"Orthop Clin North Am"},{"issue":"11","key":"ref11","doi-asserted-by":"crossref","first-page":"3537","DOI":"10.1016\/j.arth.2018.06.026","article-title":"Synovial fluid alpha-defensin is an adjunctive tool in the equivocal diagnosis of periprosthetic joint infection","volume":"33","author":"M P Kelly","year":"2018","journal-title":"J Arthroplasty"},{"issue":"02","key":"ref12","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1055\/s-0039-1698467","article-title":"Serum D-dimer in the diagnosis of periprosthetic knee infection: where are we today?","volume":"33","author":"T S Pannu","year":"2020","journal-title":"J Knee Surg"},{"issue":"24","key":"ref13","doi-asserted-by":"crossref","first-page":"2226","DOI":"10.2106\/JBJS.18.01483","article-title":"LTF, PRTN3, and MNDA in synovial fluid as promising biomarkers for periprosthetic joint infection: identification by quadrupole orbital-trap mass spectrometry","volume":"101","author":"C Wang","year":"2019","journal-title":"J Bone Joint Surg Am"},{"issue":"23","key":"ref14","doi-asserted-by":"crossref","first-page":"2057","DOI":"10.2106\/JBJS.17.01429","article-title":"Routine diagnostic tests for periprosthetic joint infection demonstrate a high false-negative rate and are influenced by the infecting organism","volume":"100","author":"M M Kheir","year":"2018","journal-title":"J Bone Joint Surg Am"},{"issue":"06","key":"ref15","doi-asserted-by":"crossref","first-page":"991","DOI":"10.1002\/art.40807","article-title":"Contemporary prevalence of gout and hyperuricemia in the United States and decadal trends: the national health and nutrition examination survey, 2007\u20132016","volume":"71","author":"M Chen-Xu","year":"2019","journal-title":"Arthritis Rheumatol"},{"issue":"09","key":"ref17","doi-asserted-by":"crossref","first-page":"1400","DOI":"10.1002\/acr.23160","article-title":"Calcium pyrophosphate deposition disease and associated medical co-morbidities: a national cross-sectional study of U.S. veterans","volume":"69","author":"C Kleiber Balderrama","year":"2017","journal-title":"Arthritis Care Res (Hoboken)"},{"issue":"02","key":"ref18","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1177\/1759720X11432559","article-title":"Treatment and management of pseudogout: insights for the clinician","volume":"4","author":"P Macmullan","year":"2012","journal-title":"Ther Adv Musculoskelet Dis"},{"issue":"06","key":"ref19","doi-asserted-by":"crossref","first-page":"1150","DOI":"10.1016\/j.arth.2019.02.018","article-title":"Inflammatory arthritis is a risk factor for multiple complications after total hip arthroplasty: a population-based comparative study of 68,348 patients","volume":"34","author":"S S Richardson","year":"2019","journal-title":"J Arthroplasty"},{"issue":"01","key":"ref20","doi-asserted-by":"crossref","first-page":"126","DOI":"10.2106\/00004623-199401000-00018","article-title":"Acute gouty arthropathy after total knee arthroplasty. A case report","volume":"76","author":"S C Williamson","year":"1994","journal-title":"J Bone Joint Surg Am"},{"issue":"04","key":"ref21","doi-asserted-by":"crossref","first-page":"e59","DOI":"10.2106\/JBJS.CC.K.00167","article-title":"Bilateral acute calcium pyrophosphate crystal arthritis after bilateral total knee arthroplasty","volume":"2","author":"J L Carter","year":"2012","journal-title":"JBJS Case Connect"},{"issue":"05","key":"ref22","doi-asserted-by":"crossref","first-page":"559","DOI":"10.1016\/j.jbspin.2016.01.006","article-title":"Crystal-induced arthritis after arthroplasty: 7 cases","volume":"83","author":"S A Yahia","year":"2016","journal-title":"Joint Bone Spine"},{"issue":"07","key":"ref23","doi-asserted-by":"crossref","first-page":"e1000097","DOI":"10.1371\/journal.pmed.1000097","article-title":"Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement","volume":"6","author":"D Moher","year":"2009","journal-title":"PLoS Med"},{"issue":"04","key":"ref24","doi-asserted-by":"crossref","first-page":"970","DOI":"10.1007\/s11999-010-1417-2","article-title":"Can this prosthesis be saved?: implant salvage attempts in infected primary TKA","volume":"469","author":"J Gardner","year":"2011","journal-title":"Clin Orthop Relat Res"},{"issue":"05","key":"ref25","doi-asserted-by":"crossref","first-page":"1309","DOI":"10.1016\/j.arth.2018.02.078","article-title":"CHen AF, Shohat N. The 2018 definition of periprosthetic hip and knee infection: an evidence-based and validated criteria","volume":"33","author":"J Parvizi","year":"2018","journal-title":"J Arthroplasty"},{"issue":"S 08","key":"ref26","doi-asserted-by":"crossref","first-page":"19","DOI":"10.5301\/HIP.2012.9566","article-title":"Value of debridement and irrigation for the treatment of peri-prosthetic infections. A systematic review","volume":"22","author":"C L Roman\u00f2","year":"2012","journal-title":"HIP International"},{"issue":"06","key":"ref27","doi-asserted-by":"crossref","first-page":"1264","DOI":"10.1093\/jac\/dkp107","article-title":"One hundred and twelve infected arthroplasties treated with \u2018DAIR\u2019 (debridement, antibiotics and implant retention): antibiotic duration and outcome","volume":"63","author":"I Byren","year":"2009","journal-title":"J Antimicrob Chemother"},{"issue":"01","key":"ref28","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1186\/1471-2474-14-222","article-title":"A systematic review of the evidence for single stage and two stage revision of infected knee replacement","volume":"14","author":"J P Masters","year":"2013","journal-title":"BMC Musculoskelet Disord"},{"issue":"02","key":"ref29","doi-asserted-by":"crossref","first-page":"107","DOI":"10.5792\/ksrr.17.095","article-title":"Chen and AF. Two-stage reimplantation in infected total knee arthroplasty","volume":"30","author":"Y S Lee","year":"2018","journal-title":"Knee Surg Relat Res"},{"issue":"12","key":"ref30","doi-asserted-by":"crossref","first-page":"992","DOI":"10.2106\/JBJS.15.01142","article-title":"The alpha-defensin immunoassay and leukocyte esterase colorimetric strip test for the diagnosis of periprosthetic infection: a systematic review and meta-analysis","volume":"98","author":"M C Wyatt","year":"2016","journal-title":"J Bone Joint Surg Am"},{"issue":"04","key":"ref31","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1007\/s00590-017-1942-8","article-title":"False-positive synovial fluid alpha-defensin test in a patient with acute gout affecting a prosthetic knee","volume":"27","author":"D G Partridge","year":"2017","journal-title":"Eur J Orthop Surg Traumatol"},{"issue":"02","key":"ref32","doi-asserted-by":"crossref","first-page":"147","DOI":"10.2106\/JBJS.17.00434","article-title":"Diagnosis of periprosthetic joint infection: the potential of next-generation sequencing","volume":"100","author":"M Tarabichi","year":"2018","journal-title":"J Bone Joint Surg Am"},{"issue":"08","key":"ref33","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1016\/j.arth.2012.02.022","article-title":"Economic burden of periprosthetic joint infection in the United States","volume":"27","author":"S M Kurtz","year":"2012","journal-title":"J Arthroplasty"},{"key":"ref34","doi-asserted-by":"crossref","first-page":"89","DOI":"10.4137\/CMAMD.S10859","article-title":"Clinical and economic burden of revision knee arthroplasty","volume":"5","author":"M Bhandari","year":"2012","journal-title":"Clin Med Insights Arthritis Musculoskelet Disord"},{"issue":"07","key":"ref35","doi-asserted-by":"crossref","first-page":"1057","DOI":"10.1016\/j.arth.2013.02.012","article-title":"Descriptive analysis of the economic costs of periprosthetic joint infection of the knee for the public health system of Andalusia","volume":"28","author":"J Garrido-G\u00f3mez","year":"2013","journal-title":"J Arthroplasty"},{"key":"ref36","first-page":"93","volume-title":"Prosthetic joint infections and cost analysis?","author":"F S Haddad","year":"2017"},{"issue":"02","key":"ref37","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1302\/0301-620X.97B2.33707","article-title":"Financial analysis of revision knee surgery based on NHS tariffs and hospital costs: does it pay to provide a revision service?","volume":"97-B","author":"R F Kallala","year":"2015","journal-title":"Bone Joint J"},{"issue":"06","key":"ref38","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1016\/j.arth.2011.03.031","article-title":"Irrigation and debridement for periprosthetic infections: does the organism matter?","volume":"26","author":"S M Odum","year":"2011","journal-title":"J Arthroplasty"},{"issue":"03","key":"ref39","doi-asserted-by":"crossref","first-page":"332","DOI":"10.1007\/s12178-018-9495-y","article-title":"Two-stage revision arthroplasty for the treatment of prosthetic joint infection","volume":"11","author":"R S Charette","year":"2018","journal-title":"Curr Rev Musculoskelet Med"},{"issue":"26","key":"ref40","doi-asserted-by":"crossref","first-page":"2575","DOI":"10.1056\/NEJMra1511117","article-title":"Calcium pyrophosphate deposition disease","volume":"374","author":"A K Rosenthal","year":"2016","journal-title":"N Engl J Med"},{"issue":"05","key":"ref41","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1056\/NEJMcp1001124","volume":"364","author":"N T Gout","year":"2011","journal-title":"N Engl J Med"},{"issue":"04","key":"ref42","first-page":"289","article-title":"The effect of synovectomy in total knee arthroplasty for primary osteoarthritis: a meta-analysis","volume":"30","author":"S S Kooner","year":"2017","journal-title":"J Knee Surg"}],"container-title":["The Journal of Knee Surgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/s-0040-1716507.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,6,20]],"date-time":"2022-06-20T23:30:26Z","timestamp":1655767826000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/s-0040-1716507"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,9,17]]},"references-count":40,"journal-issue":{"issue":"06","published-online":{"date-parts":[[2022,6,20]]},"published-print":{"date-parts":[[2022,5]]}},"URL":"https:\/\/doi.org\/10.1055\/s-0040-1716507","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["1538-8506","1938-2480"],"issn-type":[{"value":"1538-8506","type":"print"},{"value":"1938-2480","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,9,17]]}}}