Journal of Orthopedics and Joint Surgery

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VOLUME 3 , ISSUE 2 ( July-December, 2021 ) > List of Articles

CASE REPORT

The Surprising Tale of Dark Replacement

Selvaraj Velusamy, Sathyanarayana Venkat Ramaiah, Amar Murugananthan

Citation Information : Velusamy S, Ramaiah SV, Murugananthan A. The Surprising Tale of Dark Replacement. 2021; 3 (2):82-86.

DOI: 10.5005/jp-journals-10079-1036

License: CC BY-NC 4.0

Published Online: 22-09-2021

Copyright Statement:  Copyright © 2021; The Author(s).


Abstract

Alkaptonuria is caused by the defective metabolism of homogentisic acid, which causes arthritis and connective tissue pigmentation. The knee is a commonly affected joint. Total knee arthroplasty (TKA) has been suggested as an effective treatment for end-stage ochronosis arthropathy. A case of a 62-year-old man presented with pain in both knee joints and X-rays revealed advanced degenerative arthritis. During knee replacement, the subcutaneous tissues revealed blackish nodules. It was difficult to retract the patella as the patella tendon was stiff and hard with blackish discoloration. On dislocating patella, the patella tendon was avulsed on the right knee; later, it was fixed with a suture anchor and stapler. To avoid patella tendon avulsion, we did a tibial tuberosity flip osteotomy on the left knee. Ochronosis arthropathy should be considered as a diagnosis when faced with black connective tissue intraoperatively. Surgeons should anticipate patella tendon avulsion and difficulties in soft tissue balancing in the onchronitic knee and ready to tackle the complications.


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  1. Wu K, Bauer E, Myung G, et al. Musculoskeletal manifestations of alkaptonuria: a case report and literature review. Eur J Rheumatol 2018;6(2):98. DOI: 10.5152/eurjrheum.2018.18116.
  2. Harun M, Hayrettin Y, Serhat M, et al. A rare cause of arthropathy: an ochronotic patient with black joints. Int J Surg Case Rep 2014;5(8):554–557. DOI: 10.1016/j.ijscr.2014.06.015.
  3. Gil JA, Wawrzynski J, Waryasz GR. Orthopedic manifestations of ochronosis: pathophysiology, presentation, diagnosis, and management. Am J Med 2016;129(5):536.e1–536.e6. DOI: 10.1016/j.amjmed.2016.01.010.
  4. Sahoo MM, Mahapatra SK, Sethi GC, et al. Patellar ligament rupture during total knee arthroplasty in an ochronotic patient. Acta Orthop Traumatol Turc 2014;48(3):367–370. DOI: 10.3944/AOTT.2014.3245.
  5. Lee WC, Tan TL, Chan YH. Total knee arthroplasty in ochronosis arthropathy: a case report and systematic review. Case Rep Orthop 2019;2019:1871856. DOI: 10.1155/2019/1871856.
  6. Mazoochy H, Razi M. Knee and hip joint replacement surgery in a patient with ochronotic arthropathy: surgical tips. Arch Bone Jt Surg 2018;6(6):577.
  7. Spencer JM, Gibbons CL, Sharp RJ, et al. Arthroplasty for ochronotic arthritis: no failure of 11 replacements in 3 patients followed 6-12 years. Acta Orthop Scand 2004;75(3):355–358. DOI: 10.1080/00016470410001321.
  8. Manoj Kumar RV, Rajasekaran S. Spontaneous tendon ruptures in alkaptonuria. J Bone Joint Surg Br 2003;85(6):883–886. DOI: 10.1302/0301-620X.85B6.13662.
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