Skip to main content

Advertisement

SpringerLink
Log in

Does Chondrocalcinosis Affect Knee Society Scores and Range of Motion After TKA?

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Chondrocalcinosis is manifested by crystalline deposits of calcium commonly found during primary TKA for osteoarthritis. Its frequency among patients undergoing TKA is poorly defined, as is its influence on pain or function after TKA.

Questions/purposes

The purposes of this study are to (1) determine the prevalence of chondrocalcinosis in patients undergoing TKA for osteoarthritis; (2) evaluate the effect of chondrocalcinosis on ROM and The Knee Society scores; (3) determine if patients with chondrocalcinosis and severe synovitis who underwent synovectomy are at risk for lower postoperative Knee Society scores and less ROM; and (4) assess if chondrocalcinosis is associated with increased rates of revision surgery.

Methods

We retrospectively reviewed the medical records of 1500 primary TKAs performed by one surgeon. The minimum followup for patients was 24 months (average, 57 months; range, 24–120 months). There were 511 men and 934 women with an average age of 70 years. Fifty-five patients underwent bilateral knee replacements. Crystal deposition was graded prospectively during surgery using a subjective visual scale. A thorough synovectomy was performed on patients with severe synovitis and apparent crystalline deposition suggestive of calcium pyrophosphate dihydrate (CPPD) deposition (n = 50). The Knee Society scores, ROM, and revision rates were compared between patients with visible chondrocalcinosis with those without and between patients with mild chondrocalcinosis with those with severe chondrocalcinosis.

Results

Chondrocalcinosis was found in 173 male patients (34%) undergoing TKAs during this period compared with 224 female patients (24%) (p < 0.001). The Knee Society scores for knee rating and function were similar in patients with or without chondrocalcinosis undergoing TKA. However, patients with visible CPPD deposition who underwent synovectomy for proliferative synovitis had diminished final ROM and Knee Society knee rating scores (107o versus 115o knee flexion, p < 0.001 and 87 versus 94 points, p = 0.001). We cannot determine whether this result is because of the synovectomy or severity of the disease, and therefore we cannot recommend a synovectomy at this time. Revision rates were no different among patients with chondrocalcinosis compared with those without it (3.6% versus 2.2%, p = 0.2).

Conclusions

Chondrocalcinosis is common among patients undergoing TKA for osteoarthritis. The presence of CPPD deposition does not appear to affect the ROM and Knee Society scores of patients with CPPD but without severe synovitis. However, patients with severe synovitis and visible CPPD who underwent thorough synovectomy may be at risk for having decreased postoperative ROM and pain develop.

Level of Evidence

Level III, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Beutler A, Rothfuss S, Clayburne G, Sieck M, Schumacher HR Jr. Calcium pyrophosphate dihydrate crystal deposition in synovium: relationship to collagen fibers and chondrometaplasia. Arthritis Rheum. 1993;36:704–715.

    Article  PubMed  CAS  Google Scholar 

  2. Derfus BA, Kurian JB, Butler JJ, DFT lj, Carrera GF, Ryan LM, Rosenthal AK. The high prevalence of pathologic calcium crystals in pre-operative knees. J Rheumatol. 2002;29:570–574.

    PubMed  Google Scholar 

  3. Doherty M, Dieppe P, Watt I. Pyrophosphate arthropathy: a prospective study. Br J Rheumatol. 1993; 32:189–196.

    Article  PubMed  CAS  Google Scholar 

  4. Fuerst M, Bertrand J, Lammers L, Fuerst M, Bertrand J, Lammers L, Dreier R, Echtermeyer F, Nitschke Y, Rutsch F, Schäfer FK, Niggemeyer O, Steinhagen J, Lohmann CH, Pap T, Rüther W. Calcification of articular cartilage in human osteoarthritis. Arthritis Rheum. 2009;60:2694–2703.

    Article  PubMed  CAS  Google Scholar 

  5. Hernigou P, Pascale W, Pascale V, Homma Y, Poignard A. Does primary or secondary chondrocalcinosis influence long-term survivorship of unicompartmental arthroplasty? Clin Orthop Relat Res. 2012;470:1973–1979.

    Article  PubMed Central  PubMed  Google Scholar 

  6. Hirose CB, Wright RW. Calcium pyrophosphate dihydrate deposition disease (pseudogout) after total knee arthroplasty. J Arthroplasty. 2007;22:273–276.

    Article  PubMed  Google Scholar 

  7. Holt G, Vass C, Kumar CS. Acute crystal arthritis mimicking infection after total knee arthroplasty. BMJ. 2005;331:1322–1323.

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  8. Insall JN, Dorr LD, Scott RD, Scott WN. Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res. 1989;248:13–14.

    PubMed  Google Scholar 

  9. Kaushik S, Erickson JK, Palmer WE, Winalski CS, Kilpatrick SJ, Weissman BN. Effect of chondrocalcinosis on the MR imaging of knee menisci. AJR Am J Roentgenol. 2001;177:905–909.

    Article  PubMed  CAS  Google Scholar 

  10. Kilicarslan K, Yalcin N, Cicek H, Dogramaci Y, Ugurlu M, Ozkan H, Yildirim H. The effect of total synovectomy in total knee arthroplasty: a prospective randomized controlled study. Knee Surg Sports Traumatol Arthrosc. 2011;19:932–935.

    Article  PubMed  Google Scholar 

  11. Levi GS, Sadr K, Scuderi GR. Bilateral pseudogout 8 years after bilateral total knee arthroplasty. Orthop Clin North Am. 2012;43:e59–62.

    Article  PubMed  Google Scholar 

  12. Ritter MA, Berend ME, Harty LD, Davis KE, Meding JB, Keating EM. Predicting range of motion after revision total knee arthroplasty: clustering and log-linear regression analyses. J Arthroplasty. 2004;19:338–343.

    Article  PubMed  Google Scholar 

  13. Ritter MA, Harty LD, Davis KE, Meding JB, Berend M. Predicting range of motion after total knee arthroplasty: clustering, log-linear regression, and regression tree analysis. J Bone Joint Surg Am. 2003;85:1278–1285.

    PubMed  Google Scholar 

  14. Sonsale PD, Philipson MR. Pseudogout after total knee arthroplasty. J Arthroplasty. 2007;22:271–272.

    Article  PubMed  CAS  Google Scholar 

  15. Terkeltaub RA. What does articular cartilage calcification tell us about osteoarthritis? J Rheumatol. 2002;29:411–415.

    PubMed  Google Scholar 

  16. Viriyavejkul P, Wilairatana V, Tanavalee A, Jaovisidha K. Comparison of characteristics of patients with and without calcium pyrophosphate dihydrate crystal deposition who underwent total knee replacement surgery for osteoarthritis. Osteoarthritis Cartilage. 2007;15:232–235.

    Article  PubMed  CAS  Google Scholar 

  17. Wright G, Doherty M. Calcium pyrophosphate crystal deposition is not always ‘wear and tear’ or aging. Ann Rheum Dis. 1997;56:586–588.

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  18. Zhang W, Doherty M, Bardin T, Barskova V, Guerne PA, Jansen TL, Leeb BF, Perez-Ruiz F, Pimentao J, Punzi L, Richette P, Sivera F, Uhlig T, Watt I, Pascual E. European League Against Rheumatism recommendations for calcium pyrophosphate deposition. Part I: terminology and diagnosis. Ann Rheum Dis. 2011;70:563–570.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, University of Pennsylvania, 1 Cupp Pavilion, 39th and Market Streets, Philadelphia, PA, 19104, USA

    Gwo-Chin Lee MD & Paul A. Lotke MD

Authors
  1. Gwo-Chin Lee MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Paul A. Lotke MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gwo-Chin Lee MD.

Additional information

Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

About this article

Cite this article

Lee, GC., Lotke, P.A. Does Chondrocalcinosis Affect Knee Society Scores and Range of Motion After TKA?. Clin Orthop Relat Res 472, 1512–1517 (2014). https://doi.org/10.1007/s11999-013-3447-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11999-013-3447-z

Keywords

Search

Navigation