Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 6, 2022; 10(25): 9036-9043
Published online Sep 6, 2022. doi: 10.12998/wjcc.v10.i25.9036
One-stage revision arthroplasty in a patient with ochronotic arthropathy accompanied by joint infection: A case report
Xiao-Chao Wang, Xiao-Min Zhang, Wan-Ling Cai, Zhen Li, Chao Ma, Yi-Hai Liu, Qi-Lian He, Tian-Sheng Yan, Xue-Wei Cao
Xiao-Chao Wang, Zhen Li, Chao Ma, The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510000, Guangdong Province, China
Xiao-Min Zhang, Yi-Hai Liu, Qi-Lian He, Tian-Sheng Yan, Department of Orthopaedics, Xi’an International Medical Center Hospital, Xi’an 710100, Shaanxi Province, China
Wan-Ling Cai, Department of Surgery, Baoji Hospital of Traditional Chinese Medicine, Baoji 721000, Shaanxi Province, China
Xue-Wei Cao, Department of Orthopaedic Surgery, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou 510120, Guangdong Province, China
Author contributions: Wang XC, Zhang XM, Yan TS, and Cao XW designed the study; Wang XC, Zhang XM, Yan TS, Liu YH, He QL, and Cao XW performed the research; Wang XC, Cai WL, Li Z, and Ma C reviewed the literature and contributed to drafting the manuscript; all authors have read and approved the final manuscript.
Supported by Talent Training Project of Guangdong Provincial Bureau of Traditional Chinese Medicine, No. 0103030908; and Guangdong Provincial Hospital of Traditional Chinese Medicine and the School of Biomedicine, Chinese University of Hong Kong School of Medicine, Basic Clinical Collaborative Innovation Project, No. YN2018HK04.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xue-Wei Cao, MD, Chief Doctor, Department of Orthopaedic Surgery, Guangdong Provincial Hospital of Traditional Chinese Medicine, No. 111 Dade Road, Guangzhou 510120, Guangdong Province, China. wscxw123@163.com
Received: March 26, 2022
Peer-review started: March 26, 2022
First decision: April 13, 2022
Revised: April 22, 2022
Accepted: July 29, 2022
Article in press: July 29, 2022
Published online: September 6, 2022
Processing time: 152 Days and 20.4 Hours
Abstract
BACKGROUND

Ochronotic arthropathy (OcA) is a rare disease, which is caused by the accumulation of homogentisic acid in the joint. Patients with OcA have obvious joint pain and the disease progresses rapidly, eventually resulting in disability. Arthroplasty is an efficacious treatment in patients with OcA. However, when OcA patients have joint infection, is joint replacement an option? In the present report, we performed total knee arthroplasty in a patient with OcA and knee infection under the guidance of one-stage revision theory.

CASE SUMMARY

A 64-year-old male was referred to our hospital due to severe left knee pain with limited mobility for 2 years. On physical examination, the patient was found to have dark brown pigmentation of the sclera and auricle. Laboratory test results showed elevations in C-reactive protein level (65.79 mg/L) and erythrocyte sedimentation rate (90.00 mm/h). The patient underwent debridement of the left knee joint, during which the cartilage surface of the knee joint was found to be black-brown in color. Bacterial culture of synovial fluid revealed Achromobacter xylosoxidans. We then carried out arthroplasty under the guidance of the theory of one-stage revision. After surgery, the patient's left knee joint pain disappeared and function recovered without joint infection.

CONCLUSION

OcA accompanied by joint infection is rare. One-stage revision arthroplasty may be a treatment option for this disease.

Keywords: Ochronotic arthropathy; Arthroplasty; One-stage revision; Alkaptonuria; Homogentisic acid; Case report

Core Tip: Ochronotic arthropathy (OcA) is a rare disease caused by the accumulation of homogentisic acid in the joint. Compared with general arthritis patients, patients with OcA have severe pain, poor function, and high disability rate. Arthroplasty is an effective treatment for patients with end-stage OcA. However, it is unknown how to select treatment when the OcA patient has joint infection. Under guidance of the one-stage revision theory, we treated a patient with OcA accompanied by knee infection with arthroplasty. Postoperation, the patient's knee joint pain disappeared and function recovered without joint infection. One-stage revision can be a treatment for this disease.