The Effect of Arthroscopic Removal of Monosodium Urate Crystals in the Knee Joint on Patients with Gout

Abstract

Objective: To explore whether arthroscopic removal of monosodium urate crystals in the knee can reduce the frequency of acute gout attacks and improve knee function compared to medication alone. Methods: The study included 38 male patients with hyperuricemia (serum uric acid >7.0 mg/dL) who also had recurrent knee gouty arthritis. Among them, 17 patients (Group 1) underwent arthroscopic surgery to remove monosodium urate crystals from the knee, followed by staged rehabilitation exercises to help restore knee function; the remaining 21 patients (Group 2) served as the control group and received medication treatment (Combined use of uric acid-lowering and anti-inflammatory drugs). In both groups, treatment aimed to reduce and maintain serum uric acid levels between 5 and 6 mg/dL. The arthroscopic surgery group (Group 1) had a follow-up of 21.24 ± 6.92 months, while the medication group (Group 2) had 17.05 ± 6.36 months. Results: After arthroscopic surgery and medication treatment, both groups showed varying degrees of improvement in knee Lysholm scores and the frequency of acute recurrent knee gout attacks. In both indicators, Group 1 showed better outcomes than Group 2 (arthroscopic removal of knee monosodium urate crystals was more effective than medication alone). The average reduction in acute gout attacks was significantly greater in Group 1 than in Group 2 (Comparison of the number of acute gouty arthritis attacks before and after surgery in Group 1: 5.59±1.37/0.29±0.59 ;P<0.001, Group 2: 6.52±1.54/4.24±1.58 ;P<0.001), and the mean increase in Lysholm scores was also significantly higher in Group 1 than in Group 2 (Comparison of preoperative/postoperative Lysholm scores in Group 1: 68.65±3.87/85.24±4.96 ;P<.001,Group 2: 68.67±4.66/73.57±5.35 ;P<.001). Final serum uric acid levels were as follows (Group 1 preoperative/postoperative comparison 9.90±1.70/7.39±1.28; P<0.001; Group 2: 10.0±1.62/8.5±1.24; P<0.001). Conclusion: Simple uric acid-lowering and anti-inflammatory drug treatment can also improve patients' uric acid levels, the frequency of acute gout attacks, and Lysholm Scale scores. However, when pharmacotherapy is combined with arthroscopic removal of monosodium urate crystals from the knee joint, patients show more significant improvements in uric acid levels, the frequency of acute gout attacks, and Lysholm Scale scores postoperatively. This also demonstrates that arthroscopic removal of monosodium urate crystals from the knee joint is more effective for patients with knee gout.