Gout and Tophi in Bipartite Patella

Title: Tophaceous gout in the bipartite patella with intra-osseous and intra-articular lesions: A case report.
Kobayashi K, et al.
Publication: J Orthop Surg (Hong Kong). 2005 Aug;13(2):199-202.

The authors reported a 34-year old man with acute attack of gout in his knee.

Usually, the patella or the knee cap is composed of a single bone, however, the patient had a condition called “bipartite patella”. Here, the patella is composed of a main bone and a secondary bone that is connected to it by fibrous or cartilage tissue.

After conventional treatment fails to work, the patient underwent surgery. The authors found urate or uric acid crystals and inflammation of the surrounding synovial membrane of the joint. When they made a surgical incision into the joint, they found more uric acid crystals in lesions inside the bone. The authors then speculated that there was a pre-existing inflammatory condition that caused deposition of these crystal and destruction of the barrier between the deposit and the joint that caused the acute arthritic symptoms.

The authors proceeded to scrape the tophi or the crystal deposits, which led to improvement of the knee function. After 2 years, a follow-up with the patient revealed no recurrence of the symptoms.

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