Arthroscopic synovectomy for synovial hyperplasia in chronic knee gouty arthritis: A case report

Table 1 Case timeline

Date	Event
2018 to November, 2023	History of recurrent left knee effusion and chronic knee gouty arthritis
	History of allopurinol therapy from the internal medicine department for five years
November 17, 2023	Patient consulted at our outpatient clinic for recurrent left knee effusion
	Plain left knee radiograph revealed no abnormalities
	Leukocyte count: 14.43 × 109/L, C-reactive protein: 14 mg/L, and uric acid: 684.08 µmol/L
	Synovial fluid aspiration was performed
	Conservative management: Serial synovial fluid aspiration and febuxostat 80 mg/day
January 26, 2024	The symptom of recurrent left knee effusion persisted
	Uric acid: 553.21 µmol/L, and rheumatoid factor: Negative
	Synovial fluid culture: no growth of microorganisms
	MRI: Synovitis and large knee effusion
	Arthroscopic procedures were planned for diagnostic confirmation. Several differential diagnoses other than gouty arthritis, including: Septic arthritis, tuberculous synovitis, pigmented villonodular synovitis, and synovial chondromatosis
	Pre-operative IKDC score: 72.41
January 31, 2024	Patient underwent an arthroscopic procedure
	Sterile synovial fluid was obtained for culture analysis
	Intraoperative findings revealed synovial thickening and tophi deposition
	Synovial biopsy and synovectomy were performed
February 7, 2024 (one weeks postoperatively)	Synovial biopsy: chronic synovitis with synovial hyperplasia that was consistent with chronic knee gouty arthritis
	Culture of sterile synovial fluid: No growth of microorganisms
August 23, 2024 (six months postoperatively)	Patient reported no further episodes of knee effusion
	IKDC score: 96.66

IKDC: International Knee Documentation Committee; MRI: Magnetic resonance imaging.