Virginia Via Research Day Book 2026

Medical Student Research Case Reports

10 A CASE OF GOUT IN A TOTAL KNEE ARTHROPLASTY: IMPLICATIONS FOR INTERNAL MEDICINE AND ORTHOPEDICS

Jacob Barnett, OMS-IV; Annemarie Beran, DO, R1; William Cox, DO Corresponding author:jbarnett@vcom.edu

HCA - Lewis Gale Montgomery Internal Medicine Service

right knee pain, recurrent falls, and signs of sepsis. Initial evaluation revealed leukocytosis, acute kidney injury, and a right knee effusion. Empiric ceftriaxone and doxycycline were initiated. Arthrocentesis performed by orthopedic surgery demonstrated elevated synovial WBC count of 9,910 (92% neutrophils) with monosodium urate crystals. Cultures and Gram stain were negative. Given the crystal findings and stable clinical course, antibiotics were discontinued following Infectious Disease consultation. The patient improved rapidly with naproxen and colchicine therapy, and hydrochlorothiazide was discontinued to reduce urate burden. He was discharged home in stable condition with outpatient follow-up. Comments: This case underscores the diagnostic challenge of acute monoarthritis in prosthetic joints, where gout and infection share overlapping features.

Synovial fluid analysis remains the diagnostic cornerstone, and multidisciplinary collaboration among Internal Medicine, Orthopedics, and Infectious Disease is essential for appropriate management and antibiotic stewardship. Gout should be considered in the differential diagnosis of painful prosthetic joints. Early aspiration and crystal analysis can prevent unnecessary interventions and improve patient outcomes. Diagnosis: Acute gout flare involving a right total knee arthroplasty.

Context: Given the growing frequency of Total Knee Arthroplasty (TKA), it has become increasingly important to screen patients for chronic underlying conditions, such as gout, to improve post operative outcomes and potential complications. Gout involving prosthetic joints is rare but may be more common than practitioners realize due to frequent misdiagnosis as periprosthetic joint infection (PJI). Because PJI carries high morbidity, patients with gout flares are often given unnecessary antibiotics, receive unnecessary imaging, and possibly receive avoidable revision surgery. Accurate distinction between these entities is critical to prevent overtreatment, misuse of medical resources, and to optimize long term success of arthroplasty. Report of Case: We report a 75-year old male with a history of type 2 diabetes mellitus, hypertension, chronic gout, and bilateral TKAs who presented with

Table of Contents

47

2026 Research Recognition Day