{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T17:40:23Z","timestamp":1793814023596,"version":"4.6.1"},"reference-count":22,"publisher":"Public Library of Science (PLoS)","issue":"1","license":[{"start":{"date-parts":[[2025,1,24]],"date-time":"2025-01-24T00:00:00Z","timestamp":1737676800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["30801025"],"award-info":[{"award-number":["30801025"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100014103","name":"Key Research and Development Plan of Shandong Province","doi-asserted-by":"crossref","award":["2016GSF201045, 2017GSF18150"],"award-info":[{"award-number":["2016GSF201045, 2017GSF18150"]}],"id":[{"id":"10.13039\/100014103","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Shandong Province medicine health development plan","award":["2013WS0120"],"award-info":[{"award-number":["2013WS0120"]}]},{"name":"Technology Foundation for Selected Overseas Chinese Scholar"},{"name":"Qingdao people's Livelihood Science and Technology Program","award":["17-3-3-19-nsh"],"award-info":[{"award-number":["17-3-3-19-nsh"]}]},{"DOI":"10.13039\/100020868","name":"Fundaci\u00f3n para la Investigaci\u00f3n e Innovaci\u00f3n Biom\u00e9dica del Hospital Universitario Infanta Sof\u00eda y Hospital Universitario del Henares","doi-asserted-by":"publisher","award":["QDKY 2019QN09"],"award-info":[{"award-number":["QDKY 2019QN09"]}],"id":[{"id":"10.13039\/100020868","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Introduction<\/jats:title>\n<jats:p>The efficacy, safety, optimal timing, and urate-lowering effects of surgical interventions in gout management remain poorly understood. This study aims to fill this gap by evaluating the role of surgery in treating gout patients with tophi.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Method<\/jats:title>\n<jats:p>A retrospective analysis was conducted on 28 gout patients presenting with tophi. Data were comprehensively retrieved from electronic medical records, including medical history, laboratory findings, surgical procedures, hospitalization duration, postoperative monitoring, and relevant variables.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Postoperative improvements were observed in joint symptoms and functionality. Surgical intervention effectively reduced the frequency of gout flares, demonstrating short-term urate-lowering effects (STULE) and potential long-term urate-lowering effects (LTULE) when combined with urate-lowering treatments (ULT). Primary healing occurred in 65 out of 67 surgical sites (97.01%), with only 2 sites (2.99%) experiencing delayed healing, and minimal complications reported. Prolonged hospital stays were associated with elevated leukocyte counts, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) levels, as well as a higher number of surgical sites, rather than serum uric acid (SUA) levels.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Surgical intervention is a promising and safe therapeutic option for managing gout, particularly in cases with joint deterioration, functional impairment, or nerve involvement. Surgery not only reduces the frequency of gout flares but also provides STULE and potential LTULE when complemented with ULT. Patients with lower inflammatory indices and fewer incisions exhibit faster postoperative recoveries. Optimal timing of surgery, ideally during periods of disease remission, is crucial for minimizing complications and reducing hospitalization durations.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0313586","type":"journal-article","created":{"date-parts":[[2025,1,24]],"date-time":"2025-01-24T19:01:47Z","timestamp":1737745307000},"page":"e0313586","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":3,"title":["Evaluation of surgical treatment of gout\u2014A retrospective study on 28 cases with tophi"],"prefix":"10.1371","volume":"20","author":[{"given":"Ting","family":"Zhang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bin","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaohong","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zengfang","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1932-2619","authenticated-orcid":true,"given":"Zhenglun","family":"Pan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,1,24]]},"reference":[{"issue":"21","key":"pone.0313586.ref001","doi-asserted-by":"crossref","first-page":"2857","DOI":"10.1001\/jama.289.21.2857","article-title":"Gout","volume":"289","author":"KT Rott","year":"2003","journal-title":"JAMA"},{"issue":"4","key":"pone.0313586.ref002","doi-asserted-by":"crossref","first-page":"468","DOI":"10.1002\/art.1780270417","article-title":"Tophaceous gout: a clinical and radiographic assessment","volume":"27","author":"DA Nakayama","year":"1984","journal-title":"Arthritis Rheum"},{"issue":"1","key":"pone.0313586.ref003","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1186\/1757-1146-4-13","article-title":"Revisiting the pathogenesis of podagra: why does gout target the foot?","volume":"4","author":"E. Roddy","year":"2011","journal-title":"J Foot Ankle Res"},{"issue":"1","key":"pone.0313586.ref004","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1016\/j.clinbiomech.2010.09.006","article-title":"Functional and biomechanical characteristics of foot disease in chronic gout: A case-control study","volume":"26","author":"K Rome","year":"2011","journal-title":"Clin Biomech (Bristol, Avon)"},{"key":"pone.0313586.ref005","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1186\/s13047-015-0090-9","article-title":"Foot problems in people with gout in primary care: baseline findings from a prospective cohort study","volume":"8","author":"E Roddy","year":"2015","journal-title":"J Foot Ankle Res"},{"issue":"2","key":"pone.0313586.ref006","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1016\/j.jbspin.2015.03.012","article-title":"Gout and foot drop","volume":"83","author":"D Daoussis","year":"2016","journal-title":"Joint Bone Spine"},{"issue":"8","key":"pone.0313586.ref007","doi-asserted-by":"crossref","first-page":"862","DOI":"10.3928\/0147-7447-20040801-23","article-title":"Carpal tunnel syndrome due to tophaceous gout","volume":"27","author":"JT Rich","year":"2004","journal-title":"Orthopedics"},{"issue":"12","key":"pone.0313586.ref008","doi-asserted-by":"crossref","first-page":"1804","DOI":"10.1093\/rheumatology\/kem246","article-title":"Tophaceous joint disease strongly predicts hand function in patients with gout","volume":"46","author":"N Dalbeth","year":"2007","journal-title":"Rheumatology (Oxford)"},{"key":"pone.0313586.ref009","first-page":"7201312","article-title":"Multiple tophaceous gout of hand with extensor tendon rupture","volume":"2017","author":"H Tobimatsu","year":"2017","journal-title":"Case Rep Orthop"},{"issue":"3","key":"pone.0313586.ref010","doi-asserted-by":"crossref","first-page":"384","DOI":"10.1002\/acr.20670","article-title":"Foot pain, impairment, and disability in patients with acute gout flares: A prospective observational study","volume":"64","author":"K Rome","year":"2012","journal-title":"Arthritis Care Res (Hoboken)"},{"key":"pone.0313586.ref011","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1016\/j.gaitpost.2015.11.004","article-title":"Foot-related pain and disability and spatiotemporal parameters of gait during self-selected and fast walking speeds in people with gout: A two-arm cross sectional study","volume":"44","author":"S Stewart","year":"2016","journal-title":"Gait Posture"},{"issue":"6","key":"pone.0313586.ref012","doi-asserted-by":"crossref","first-page":"669","DOI":"10.1016\/j.semarthrit.2016.01.005","article-title":"Treatment of tophaceous gout: When medication is not enough","volume":"45","author":"IR Kasper","year":"2016","journal-title":"Semin Arthritis Rheum"},{"key":"pone.0313586.ref013","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1097\/00003086-197007000-00008","article-title":"Surgical management of tophaceous gout","volume":"71","author":"WA Larmon","year":"1970","journal-title":"Clin Orthop Relat Res"},{"issue":"3","key":"pone.0313586.ref014","doi-asserted-by":"crossref","first-page":"262","DOI":"10.1016\/0049-0172(72)90005-4","article-title":"Surgery of tophaceous gout","volume":"1","author":"PA Cassagrande","year":"1972","journal-title":"Semin Arthritis Rheum"},{"issue":"2","key":"pone.0313586.ref015","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1097\/00000658-194302000-00002","article-title":"The surgical treatment of tophaceous gout","volume":"117","author":"RR Linton","year":"1943","journal-title":"Ann Surg"},{"issue":"1158","key":"pone.0313586.ref016","first-page":"U109","article-title":"A survey of indications, results and complications of surgery for tophaceous gout","volume":"115","author":"S Kumar","year":"2002","journal-title":"N Z Med J"},{"issue":"5","key":"pone.0313586.ref017","doi-asserted-by":"crossref","first-page":"669","DOI":"10.1016\/j.bjps.2007.12.021","article-title":"Surgical treatment of the chronic tophaceous deformity in upper extremities\u2014the shaving technique","volume":"62","author":"SS Lee","year":"2009","journal-title":"J Plast Reconstr Aesthet Surg"},{"issue":"6","key":"pone.0313586.ref018","first-page":"440","article-title":"Surgery for tophaceous gout","volume":"23","author":"JP Frankel","year":"1984","journal-title":"J Foot Surg"},{"issue":"9","key":"pone.0313586.ref019","first-page":"1950","article-title":"The inflammatory process in the mechanism of decreased serum urate concentrations during acute gouty arthritis","volume":"29","author":"W Urano","year":"2002","journal-title":"J Rheumatol"},{"issue":"6","key":"pone.0313586.ref020","first-page":"480","article-title":"The last defence? Surgical aspects of gouty arthritis of hand and wrist","volume":"17","author":"CY Tang","year":"2011","journal-title":"Hong Kong Med J"},{"issue":"8","key":"pone.0313586.ref021","doi-asserted-by":"crossref","first-page":"1131","DOI":"10.1016\/j.bjps.2013.03.041","article-title":"Timing of intra-lesion shaving for surgical treatment of chronic tophus","volume":"66","author":"SS Lee","year":"2013","journal-title":"J Plast Reconstr Aesthet Surg"},{"key":"pone.0313586.ref022","first-page":"A2141","article-title":"Coincident gout and bacterial infection","volume":"154","author":"JW Jacobs","year":"2010","journal-title":"Ned Tijdschr Geneeskd"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0313586","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,1,24]],"date-time":"2025-01-24T19:02:03Z","timestamp":1737745323000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0313586"}},"subtitle":[],"editor":[{"given":"Fulvio","family":"D\u2019Acquisto","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,1,24]]},"references-count":22,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,1,24]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0313586","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,24]]}}}