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Calcium pyrophosphate deposition disease (CPPD), known as pseudogout, is characterized by the accumulation of calcium pyrophosphate crystals in musculoskeletal structures, primarily joints. While CPPD commonly affects various joints, involvement in the cervical spine leading to myelopathy is rare. Surgical intervention becomes necessary when conservative measures fail, but reports on full endoscopic surgeries are extremely rare. We present two successful cases where full endoscopic systems were used for CPPD removal in the cervical spine. The surgical technique involved a full endoscopic approach, adapting the previously reported technique for unilateral laminotomy bilateral decompression. Full-endoscopic removal of cervical CPPD inducing myelopathy were successfully removed with good clinical and radiologic outcomes. The scarcity of endoscopic cases for cervical ligamentum flavum CPPD is attributed to the condition's rarity. However, our successful cases advocate for endoscopic surgery as a potential primary treatment option for CPPD-induced cervical myelopathy, especially in elderly patients or those with previous cervical operation histories. This experience encourages the consideration of endoscopic surgery for managing cervical ligamentum flavum CPPD as a viable alternative., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Austria, part of Springer Nature.)

Calcium pyrophosphate dihydrate deposition disease (CPDD or pseudogout) is a degenerative joint disease. It is defined by the presence of calcium pyrophosphate dihydrate crystals. It usually manifests in the knee and wrist. Manifestation in the temporomandibular joint (TMJ) is only reported in case reports. We present a patient with CPDD mimicking a malignant tumor of the TMJ. A 53-year-old woman presented with progressive pain and a slow-growing swelling of the left TMJ. Imaging showed an extensive mass in the infratemporal fossa extending into the middle cranial fossa and compressing the temporal lobe. Assuming a potential malignancy, we excised the growth, which extended into the dura. We covered the resulting tissue defect within the primary surgery using a microsurgically anastomosed scapular flap and performed further reconstructive surgeries. Calcium pyrophosphate dihydrate crystals were found in the histopathologic examination of the excised tissue, resulting in the diagnosis of CPDD. That is a benign diagnosis, but we treated it like a malignancy. This leads us to the question, was there overtreatment? Tumoral CPDD in the TMJ can be a difficult diagnosis to obtain. The treatment remains controversial, but complete excision of the mass was performed in most reported cases., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Purpose: Meniscal tears or histological meniscal calcifications (in the absence of radiological chondrocalcinosis) are frequent in osteoarthritis. Whether lateral meniscal lesions influence clinical outcomes after medial unicompartmental knee arthroplasty (UKA) is unknown., Methods: We analyzed 130 patients (130 knees) with medial unicompartmental knee arthroplasties between 2005 and 2015. These 130 knees had full articular cartilage thickness in the lateral compartment and no radiological chondrocalcinosis on preoperative radiographs. The lateral meniscus was analyzed with preoperative MRI and a biopsy of the anterior horn at the time of surgery. Synovial fluid was collected and analyzed for calcium pyrophosphate dihydrate crystal deposition (CPPD crystals). Lateral meniscal tears were untreated when detected on MRI or during surgery, with the hypothesis that these tears on the opposite compartment would remain asymptomatic in medial UKA. At average 10-year follow-up, patients were evaluated with clinical and radiographic outcome, with a focus on the risk of joint space narrowing of the lateral femorotibial compartment., Results: CPPD crystals were present in the synovial fluid of 70 knees. Lateral meniscal tears were seen on MRI in 34 (49%) normal meniscuses of the 60 knees without CPPD crystals and in six other knees without histological meniscal calcification despite CPPD crystals. Histological calcification was present on 61 lateral meniscuses with 53 meniscal tears. The results showed no significant differences in the clinical outcomes between knees with lateral meniscal tears or lateral meniscal histological chondrocalcinosis or both lesions and those without these conditions. Additionally, radiographic progression of osteoarthritis in the opposite femorotibial compartment of the knee was not more frequent in patients with these meniscal issues. The ten year cumulative survival rates, measured by the need for total knee arthroplasty, were 91% for knees without meniscal lesions and 92% for knees with these lesions., Conclusion: On this basis, treatment of meniscal tears of the lateral compartment and routine aspiration of the knee to assess for birefringent crystals in the planning of medial UKA do not appear necessary., (© 2023. The Author(s) under exclusive licence to SICOT aisbl.)

Tophaceous pseudogout is a rare variant of the calcium pyrophosphate dihydrate (CPPD) disorder, with predilection for the TMJ. It is characterized by calcific deposits composed of rhomboid- or rectangular-shaped crystals that exhibit birefringence when examined under polarized light. We hereby present a case of a 65-year-old man with left pre-auricular tenderness and malocclusion. CT imaging was notable for a left TMJ mineralized mass with erosion of the condylar head. Treatment involved excision of the mass with eminectomy, condylectomy, and a stock total TMJ reconstruction. In this report, important considerations for diagnosis, biopsy, and surgical treatment with emphasis on reconstruction for tophaceous pseudogout of the TMJ have been highlighted by the authors., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

This cross-sectional study aims to evaluate the predictors, outcomes, and resource utilization of total knee arthroplasty (TKA) in calcium pyrophosphate deposition disease (CPPD) patients. We used the US National Inpatient Sample database to identify CPPD and non-CPPD who underwent TKA from 2006 to 2014. Data collection included patient demographics and comorbidities. Outcomes following TKA included in-hospital mortality, complications, length of hospitalization, hospital charges, and disposition. Among the 5,564,005 patients who have undergone TKA, 11,529 (0.20%) had CPPD, with a median age of 72 years, and 53.7% were females. Compared with non-CPPD, patients with CPPD were more likely to be older (mean 72 vs 66 years; p < 0.001), male, white, and have Medicare insurance. CPPD patients were more likely to have ≥ 2 comorbidities calculated by the Charlson Comorbidity Index and discharge to an inpatient/rehabilitation facility. Regarding inpatient complications, myocardial infarction and knee reoperation were significantly more common in CPPD patients. TKA in CPPD patients was associated with significantly higher odds of increased length of stay (> 3 days) than those without CPPD (OR 1.43, 95% CI 1.37-1.49). There was no significant difference in the in-hospital mortality even after adjusting for possible confounders. CPPD patients who underwent TKA were more likely to have a longer hospital stay and discharge to a non-home setting than non-CPPD. Also, CPPD patients had a higher comorbidity burden and risk for myocardial infarction and reoperation.Key Points• This is the largest study to analyze data of CPPD patients who underwent TKA and compare them with non-CPPD patients, using a large nationwide database.• Compared to non-CPPD patients, TKA in CPPD patients is associated with a greater length of stay and disposition to a nursing/rehabilitation facility.• In-hospital complications such as myocardial infarction and reoperation were more frequently observed in CPPD patients than non-CPPD.• The results of this study should alert healthcare providers to develop strategies in order to improve outcomes of CPPD patients undergoing TKA., (© 2022. International League of Associations for Rheumatology (ILAR).)

Purpose: There are contentious data about the role calcium pyrophosphate (CPP) crystals and chondrocalcinosis (CC) play in the progression of osteoarthritis (OA), as well as in the outcomes after knee arthroplasty. Hence, the purpose of this systematic review was to analyse the clinical and functional outcome, progression of OA and prosthesis survivorship after unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA) in patients with CC compared to patients without CC., Methods: A systematic review of the literature in PubMed, Medline, Embase and Web of Science was performed using the "Preferred Reporting Items for Systematic Reviews and Meta-Analysis" (PRISMA) guidelines. Articles which reported the outcome and survival rates of prosthesis after TKA or UKA in patients with CC were included., Results: A total of 3718 patient knees were included in eight selected publications, with a median sample sizes of 234 knees (range 78-1000) and 954 knees (range 408-1500) for publications including UKA and TKA, respectively. At time of surgery, the mean age was 69 years and the prevalence for CC ranged from 12.6 to 36%. Chondrocalcinosis did not significantly influence the functional and clinical outcome, the implant survival as well as the radiologic progression of OA disease after UKA and TKA., Conclusion: The presence of CPP crystals in tissue samples, synovial fluid or evidence of calcifications on preoperative radiographs did not significantly influence the postoperative functional and activity scores. It also had no significant influence on prosthesis survival rate, whether it was a UKA or a TKA. This study shows that the impact of a subclinical form of chondrocalcinosis may not be of clinical relevance in the context of arthroplasty., Level of Evidence: IV., (© 2021. The Author(s).)

Pseudogout, also known as calcium pyrophosphate deposition disease, is an inflammatory arthropathy that primarily occurs in the peripheral joints, such as the knee or elbow. Spinal pseudogout is uncommon, and neck pain is its most common clinical manifestation. However, cervical myeloradiculopathy as an initial presentation of pseudogout attack of the ligamentum flavum has rarely been reported in the literature. We report a case of a 65-year-old woman who presented with neck pain, bilateral finger numbness, and left-sided upper extremity weakness. Magnetic resonance images showed an epidural mass at the C4-5 level, compressing the spinal cord. Following laminectomy with removal of the calcified mass, the profound neurologic deficits gradually recovered. A pathological examination confirmed the diagnosis of cervical pseudogout., (Copyright: © Neurosciences.)

Background: There are few reports of cervical myelopathy caused by an attack of subaxial calcium pyrophosphate dihydrate (CPPD) deposition. Moreover, there has been no report on cervical myelopathy by subaxial CPPD deposition with simultaneous asymptomatic crowned dens syndrome (CDS) at the same time., Case Presentation: The first case was a 68-year-old male complaining of cervical myelopathic symptoms. Plain radiographs, computed tomography (CT) and magnetic resonance imaging (MRI) findings revealed spinal cord compression by calcified round lesions at C4 as well as a calcified lesion behind the dens. The second case was a 77-year-old female complaining of cervical myelopathic symptoms. Plain radiographs, CT and MRI findings revealed spinal cord compression by calcified round lesions at C3 and C4 as well as a calcified lesion behind the dens. In both cases, we believed that the calcified lesion behind the dens was an asymptomatic lesion. Therefore, the first patient received decompressive laminectomy of C3 and C4, removal of calcified round lesions, and posterior fixation from C3 to C5 due to associated kyphosis. The second patient underwent decompressive laminectomy of C3 and C4 and removal of calcified round lesions. Microscopic examination under polarized light showed dark blue calcifications with rhomboid crystals that were positively birefringent. The findings were consistent with those of CPPD., Conclusions: This is the first study to report cervical myelopathy caused by subaxial CPPD deposition with simultaneous asymptomatic CDS. Surgical removal of the subaxial CPPD deposition alone achieved a satisfactory surgical outcome without recurrence.

Introduction: In total knee replacement surgery, medio-lateral knee balancing is recognized as the key to achieving satisfactory functional results. But it may not be enough to stabilize the flexion gap using deep-dished implants. We achieved flexion gap balance by oversizing the femoral component, thus increasing the posterior condylar offset (PCO). The purpose of this study was to describe the applicability of this technique and to test whether it produced adverse effects on medium-term outcomes. We hypothesized that it would not compromise the results if used properly. We therefore asked: (1) at how many cases of flexion gap balance would require oversizing the femoral component; (2) if femoral components oversizing would modify the mid-term results as per forgotten joint score (FJS) scores and whether flexion gain would be comparable to patients in whom it was not increased., Materials and Methods: Ninety-four patients (120 knees) were operated between September 2009 and 2011 (age 68±9 years) using the cementless Hyperflex version of the Natural Knees (Zimmer, Warsaw, IN, USA). Postero stabilization was achieved using deep-dished inserts. The Gender configuration has provided narrow inserts to better adapt the female anatomy. A special navigation system measured the displacement of the lateral and medial femoro-tibial contact points with infra-millimetric precision. Adopting a tibial cut first, gap-balancing technique with anterior referencing, the decision to oversize the femoral component relied on the 90° flexion drawer test, which showed more than 6mm sagittal laxity before the femoral bone cuts. Eighty-one (105 knees) patients were reviewed with average 63±27-month follow-up., Results: Femoral components were augmented by 1 size in 60 cases and by 2 sizes in 7 cases. At final review, knees with an oversized femoral component (60) achieved the same results as those implanted with a non-oversized femoral component (n=45) in terms of mean flexion gain (-5°±34 versus -4°±23, p=0.78), mean FJS (63±26 versus 61±23; p=0.56)., Conclusion: Balancing the Flexion gap by oversizing the femoral component did not compromise flexion range and functional results., Level of Evidence: IV, Retrospective cohort study., (Copyright © 2019 Elsevier Masson SAS. All rights reserved.)

Background: The association between the synovial chondromatosis (SC) and the calcium pyrophosphate deposition (pseudogotta) in temporomandibular joint (TMJ) is very rare and has been described just 1 patient in the literature., Clinical Presentation: A 64-year-old woman was referred to Dipartimento di Scienze Odontostomatologiche e Maxillo-Facciali, Sapienza Università di Roma after complaining about right temporomandibular pain, limitation in mandibular movements, and tumefaction in the right preauricular region. The patient was hospitalized for the surgery. The microscopic examination of the excised material revealed calcium pyrophosphate dihydrate (CPPD) deposits crystals associated with cartilaginous proliferation., Conclusion: The association between the SC and the calcium pyrophosphate deposition (pseudogotta) is a challenging diagnosis among TMJ neoplasms.

Arthropathy of the hand is commonly encountered. Contributing factors such as aging, trauma, and systemic illness all may have a role in the evolution of this pathology. Besides rheumatoid arthritis, other diseases affect the small joints of the hand. A review of nonrheumatoid hand arthropathies is beneficial for clinicians to recognize these problems., (Copyright © 2018 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.)

Background: Glenohumeral exploration is routinely performed during arthroscopic removal of rotator cuff calcifications in patients with calcific tendinitis of the shoulder (CTS). However, evidence on the prevalence of intraarticular co-pathologies is lacking and the benefit of glenohumeral exploration remains elusive. The aim of the present study was to assess and quantify intraoperative pathologies during arthroscopic removal of rotator cuff calcifications in order to determine whether standardized diagnostic glenohumeral exploration appears justified in CTS patients., Methods: One hundred forty five patients undergoing arthroscopic removal of calcific depots (CD) that failed conservative treatment were included in a retrospective cohort study. Radiographic parameters including number/localization of calcifications and acromial types, intraoperative arthroscopic findings such as configuration of glenohumeral ligaments, articular cartilage injuries, and characteristics of calcifications and sonographic parameters (characteristics/localization of calcification) were recorded., Results: One hundred forty five patients were analyzed. All CDs were removed by elimination with a blunt hook probe via "squeeze-and-stir-technique" assessed postoperatively via conventional X-rays. Neither subacromial decompression nor refixation of the rotator cuff were performed in any patient. Prevalence of glenohumeral co-pathologies, such as partial tears of the proximal biceps tendon (2.1%), superior labral tears from anterior to posterior (SLAP) lesions (1.4%), and/or partial rotator cuff tears (0.7%) was low. Most frequently, glenohumeral articular cartilage was either entirely intact (ICRS grade 0 (humeral head/glenoid): 46%/48%) or showed very mild degenerative changes (ICRS grade 1: 30%/26%). Two patients (1.3%) required intraarticular surgical treatment due to a SLAP lesion type III (n = 1) and an intraarticular rupture of CD (n = 1)., Conclusions: Routine diagnostic glenohumeral exploration does not appear beneficial in arthroscopic treatment of CTS due to the low prevalence of intraarticular pathologies which most frequently do not require surgical treatment. Exploration of the glenohumeral joint in arthroscopic removal of CD should only be performed in case of founded suspicion of relevant concomitant intraarticular pathologies.

Case: A 55-year-old man presented with a history of forefoot pain and swelling. Radiographs revealed a mass with internal calcifications and osseous erosion of the fifth metatarsophalangeal bone. The mass was isointense to muscle on T1-weighted magnetic resonance imaging (MRI) and hyperintense on T2-weighted MRI. A biopsy was performed, and intraoperatively, the lesion appeared as chalky white material, which under polarized light microscopy was composed of weakly positively birefringent rhomboid crystals, leading to a diagnosis of tophaceous pseudogout., Conclusion: Tophaceus pseudogout should be included in the differential diagnosis of neoplastic-appearing lesions in the foot, and polarized light microscopy should be used when examining biopsy specimens.

Background: Operative treatment of chondrocalcinosis (calcium pyrophosphate dihydrate deposition disease=CPPD disease) of the wrist is hardly ever mentioned in the literature. Since the chronic, recurrent type of this disease resembles rheumatoid arthritis (RA) as well as osteoarthritis, the author has performed arthroscopic synovectomy of the wrist, which achieves excellent results in RA und offers high patient comfort as an atraumatic procedure with low morbidity. This article presents the experience made with arthroscopic synovectomy in CPPD disease of the wrist., Patients and Methods: Out of 74 arthroscopic synovectomies in 71 patients with symptomatic CPPD disease of the wrist, 46 operations in 43 patients were followed for an average of 26.6 months after surgery. 15 women and 28 men at an average age of 64.5 (42-90) years had a telephone interview and were asked for pain, functional impairment and satisfaction with the intervention. Intraoperative and histologic findings were recorded. According to the Romano Classification, there was SCAC (scaphoid chondrocalcinosis advanced collapse) I in 6 cases (13%), SCAC II in 18 (39%), SCAC III in 9 (19.5%) and SCAC IV in 3 cases (6.5%). In 10 X-rays, classification according to Romano was not possible., Results: There was a significant reduction in pain at rest and on weight-bearing as well as a significant improvement in hand function. 74% of patients would chose to undergo the intervention again. Arthroscopy revealed the typical symptoms of CPPD disease in all cases. In 38 out of the 46 operations, a histologic examination was performed and was positive in 20 cases., Conclusions: Arthroscopic synovectomy of the wrist in patients with CPPD disease provides high patient satisfaction regardless of the radiologic stage. The procedure is atraumatic with low morbidity and high patient comfort. The Romano Classification should be supplemented by an additional early stage, SCAC 0. More often than suspected, CPPD disease may be responsible for wrist pain of unknown origin even in middle-aged patients., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: Calcification of the yellow ligament sometimes compresses the spinal cord and can induce myelopathy. Usually, the calcification does not induce acute neck pain. We report a case of a patient with acute neck pain caused by calcium pyrophosphate dihydrate in a calcified cervical yellow ligament., Case Presentation: A 70-year-old Japanese woman presented with acute neck pain. She had a moderately high fever (37.5 °C), and her neck pain was so severe that she could not move her neck in any direction. Computed tomography showed a high-density area between the C5 and C6 laminae suspicious for calcification of the yellow ligament. Magnetic resonance imaging showed intermediate-signal intensity on T1-weighted imaging and high-signal intensity on T2-weighted imaging surrounding a low-signal region on both T1- and T2-weighted imaging with cord compression. There was a turbid, yellow fluid collection in the yellow ligament at the time of operation. Histologically, calcium pyrophosphate dihydrate crystals were found in the fluid, and she was diagnosed as having a pseudogout attack of the yellow ligament., Conclusions: Pseudogout attack of the cervical yellow ligament is rare, but this clinical entity should be added to the differential diagnosis of acute neck pain, especially when calcification of the yellow ligament exists.

The authors present a case of a 60-year-old woman with a destructive painful condition in the right temporomandibular joint (TMJ) that proved to be calcium pyrophosphate crystal deposits at subsequent biopsy examination. The patient presented with the chief complaints of pain and limitation that had not resolved with splint therapy, medications, and habit control. Magnetic resonance imaging studies showed internal derangement without reduction. Right TMJ arthroscopy with manipulation of the jaw under anesthesia showed unique findings of fronds of synovial tissue in the posterior joint space and areas of white matter. Because there was no long-term improvement in her clinical symptoms, she subsequently underwent arthroplasty of the right joint, with the white material clearly seen at surgery, and the biopsy examination confirmed the clinical and arthroscopic impression of pseudogout. The presentation, diagnosis, pathology, and treatment of pseudogout of the TMJ are discussed., (Copyright © 2015 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

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 (107(o) versus 115(o) 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.

Objective: We report a series of 3 cases of tophaceous pseudogout of the temporomandibular joint (TMJ)., Study Design: Three patients, two men and one woman, ranging in age between 60 and 75 years, presented with unilateral painful swelling of the TMJ area associated with limitation of mouth opening., Results: Radiographic and computed tomographic images showed opaque masses in the supracondylar region of the TMJ. The preoperative clinical impression was a "neoplastic lesion" in the 3 cases. Microscopic examination revealed numerous deeply basophilic masses of calcified deposits, exhibiting birefringence under polarized light and morphologically consistent with calcium pyrophosphate dihydrate deposition, referred to in these cases as "tophaceous pseudogout.", Conclusion: Tophaceous pseudogout is a rare benign arthropathy that presents with clinical and radiographic features mimicking neoplastic conditions of the TMJ. Therefore, it is recommended that tophaceous pseudogout be considered in the differential diagnosis when a TMJ is involved with "neoplasm-like" lesions clinically and radiographically., (Published by Mosby, Inc.)

Pseudogout, also known as calcium pyrophosphate dihydrate deposition disease (CPPD) with giant cell reparative granuloma (GCRG) of the temporal bone is a rare disease, which is very easy to misdiagnose. When two diseases occur simultaneously, the pathological tissue of diseases is closely associated, which complicates clinical representation and causes enormous difficulty in diagnosis and treatment. We report a case of CPPD of the temporomandibular joint accompanied by surrounding GCRG of temporal bone in a 62-year-old male., (© 2013 Elsevier Inc. All rights reserved.)

Calcium pyrophosphate dihydrate (CPPD) crystal deposition disease is one of the most common forms of crystal-associated arthropathy in the elderly. However, cervical spine is rarely affected, especially in upper cervical area. There have been previous reported cases of symptomatic retro-odontoid CPPD deposition disease in English literature but this case is the first reported in Thai patients. This is a case report of a 67-year-old man who presented with neck pain with progressive myelopathy. Neurologic examination demonstrated a cervical myelopathy with muscle weakness and sensory disturbance of both extremities. Imaging studies showed extradural retro-odontoid mass compressing the spinal cord. The patient underwent occiput to C3 fusion with plating, posterior arch of atlas resection, transoral odontoidectomy, and mass removal. Histological examination of the mass revealed fibrocartilage tissue and rhomboid shaped crystals that showed positive biferingent in polarized light microscopy consistent with CPPD crystals. After surgery, no complication was found, and his neurological function had improved.

We report a case of an 80-year-old woman with an acute carpal tunnel syndrome. This was based on an acute episode of chondrocalcinoses and accompagnied by a prolaps of the median nerve into a gap of the forearm fascia as result of a cut injury in childhood., (© Georg Thieme Verlag KG Stuttgart · New York.)

Introduction: Calcium pyrophosphate dihydrate crystal deposition disease (CPPDD) is a rare benign inflammatory joint disorder characterized by the presence of calcium pyrophosphate dihydrate crystal in the interarticular and periarticular tissue. It has been rarely described with spinal localization., Methods: A 50-year-old woman, affected by CPPDD, presented a progressive weakness of both lower limbs associated with neurogenic claudication. Neuroradiological examinations revealed the presence of two intradural calcified lesions at level L3-L4, with no post-contrast enhancement., Results: Surgery was performed and the histopathological exams documented the presence of rod-shaped crystals embedded in a fibrocartilaginous stroma. The postoperative course was uneventful and the patient experienced complete symptoms relief with a 5-year follow-up., Conclusion: Intradural CPPD localization at the filum terminale is an extremely rare occurrence. Total removal should be preferably attempted with a long-term focal control of the disease as we observed in our case.

We report a case of closed rupture of the flexor tendons of the little finger caused by calcium pyrophosphate dihydrate crystal deposition disease of the pisotriquetrum joint. The patient could not flex the little finger and did not have wrist pain. Plain radiographs of the affected wrist joint showed severe arthritic changes of the pisotriquetrum joint and calcification around the joint. At operation, the pisotriquetrum joint capsule was ruptured and involved the flexor tendon of the little finger. The distal stump of the flexor tendon was transferred to the flexor tendon of the ring finger, and the pisiform was resected. Histological examination with polarized light microscopy revealed crystals showing weakly positive birefringence in the calcification.

Objective: To investigate the clinicopathologic features of calcium pyrophosphate dihydrate crystal deposition disease (CPPD-CDD)., Methods: The clinical and pathologic profiles were retrospectively analysed in 20 cases of CPPD-CDD., Results: CPPD-CDD was far more common in women, most frequently involving joints, especially the knees and presenting with various arthrisis. Abnormally calcified and the articular damages were characteristic features by imageing. Histologically, multifocal indigo granular calcinosis was seen in synovium and sometimes appeared as needle-shaped or rhomboid crystals, which characterized the CPPD., Conclusions: Though clinical symptoms of CPPD are quite variable, the definite diagnosis can be made by the abnormal calcification and joint damage radiographically and the indigo CPPD crystals histopathologically.

This article presents the clinical features of crystal arthropathy after knee replacement. The current literature on pseudogout and gout after both total and partial knee replacement is summarized. A case of bilateral pseudogout 8 years after initial total knee arthroplasty (TKA) is used to highlight the clinical characteristics and treatment options for this underrecognized condition. Presentation mimicked a late septic joint arthroplasty with sudden onset of pain and effusion. The patient was treated successfully with an arthrotomy, debridement, synovectomy, polyethylene insert exchange, oral steroids, and nonsteroidal anti-inflammatories. There are no other reported cases of bilateral pseudogout after bilateral TKA., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Pseudogout of the lumbar facet joints is rare. We report on a 69-year-old woman with 2-level symptomatic synovial cysts of the facet joints caused by calcium pyrophosphate dihydrate crystal deposition. She underwent surgical decompression for sciatica and low back pain. At one-year follow-up, she had recovered completely.

The acute calcium deposit belongs to the group of calcium pyrophosphate dihydrate deposition disease (CPPD). It occurs in adults. To our knowledge there is no report on an acute or chronic calcium deposit in children or adolescents. We report on 2 cases of acute and chronic calcium deposit in young patients., (© Georg Thieme Verlag KG Stuttgart · New York.)

Calcium pyrophosphate dihydrate deposition disease (CPDD, tophaceous pseudogout) is a rare crystal arthropathy characterized by pyrophosphate crystal deposition in joints, synovitis and chondrocalcinosis on imaging. We present the case of a 72-year-old man with 6 months of left chest pain; magnetic resonance imaging revealed a T9/T10 herniated disc. Intraoperatively, the material was sent for pathological analysis revealing pseudogout. Axial calcium pyrophosphate crystal deposition is rare but reported in the literature and found at the craniocervical junction and skull. Spinal calcium pyrophosphate crystal deposition is rare in the thoracic spine. It is often asymptompatic and can involve the disc or ligaments. This case demonstrates a unique presentation of CPDD.

Purpose: The aim of this study is to analyse the influence of femoral cement on clinical and radiological results after total knee arthroplasty., Methods: Preoperatively 130 patients were randomly assigned to treatment in either the Cement Group or the Hybrid Group. The International Knee Society scores, femoral radiolucent lines and bone transparencies were compared., Results: There were no significant differences concerning postoperative knee and function scores. We observed a significant difference in radiolucent lines (Cement Group, 24%; Hybrid Group, 2%; P < 0.001) as well as bone transparencies (Cement Group, 21%; Hybrid Group, 62%; P < 0.001). All radiolucent lines measured less than 2 mm in width., Conclusion: Cementing the femoral component of a total knee arthroplasty does not appear to influence the clinical results. A longer follow-up period is required to determine the influence of radiological findings on final outcome.

Background: Pseudogout, or calcium pyrophosphate deposition, is a rare cause of pain, swelling, and trismus of the temporomandibular joint (TMJ). Diagnosis and management of the lesion are discussed., Case Description: A 58-year-old female had a 2-month history of progressive swelling of right TMJ associated with trismus and facial pain. Imaging of the TMJ revealed a mixed radiolucent and radiopaque lesion associated with the right TMJ joint space. Surgical excision was performed successfully via preauricular approach. Pathology was consistent with calcium pyrophosphate deposition of the TMJ, also known as pseudogout. Surgical excision successfully treated her symptoms as expected. She is now disease free without recurrence., Clinical Implications: Pseudogout is a rare cause of TMJ pain, swelling, and trismus that should be included in the differential of joint pain and dysfunction. It can be treated successfully with surgery., (Copyright © 2011 Mosby, Inc. All rights reserved.)

Purpose: We reviewed 21 consecutive patients who underwent a total wrist arthroplasty as a primary procedure between October 2001 and February 2007. The purposes of the present study were to communicate our midterm results and to compare them with previously published series., Methods: We evaluated all patients clinically and radiologically. We used the Patient-Related Wrist Evaluation a primary outcome measure. The mean follow-up was 5.5 years (range, 3-8 years). A total of 14 patients had rheumatoid arthritis, including 1 with juvenile arthritis, and 1 each had psoriatic arthritis, systemic lupus erythematosus, and undifferentiated spondyloarthropathy. Of the remaining 4 patients, 2 had grade IV Kienböck disease, 1 had degenerative arthrosis, and 1 had chondrocalcinosis., Results: Postoperative Patient-Related Wrist Evaluation scores averaged 24 points (SD, 21 pints) out of 100 (worst score). When the patients were specifically asked about pain and function of the arthroplasty, 20 claimed to be satisfied or very satisfied with the procedure. Two early and 3 late complications occurred. One patient had a wound hematoma and another had a superficial wound infection, both of which resolved with no further complications during the immediate postoperative period. In 2 patients, there was some osteolysis around the screw inserted into the medullary canal of the index metacarpal, but not in the trapezoid bone. One patient had a slight loosening of the distal component with subsidence on the ulnar side of the carpus. There have been no dislocations or surgical revisions of the components., Conclusions: Based on our study, a total wrist arthroplasty should be considered as a good alternative to arthrodesis for patients who wish to preserve some degree of mobility of the wrist., Type of Study/level of Evidence: Therapeutic IV., (Copyright © 2011 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.)

Purpose: We report the unusual case of a 63-year-old man with gout and coexisting pseudogout (calcium pyrophosphate dihydrate crystal deposition disease) affecting the same joint. In this report, we describe the clinical features of the patient in addition to the characteristics of the crystals extracted from his affected joint, examined using compensated polarized microscopy., Methods: Synovial fluid and specimens of the lateral meniscus of the patient's knee joint taken during arthroscopy were analyzed using compensated polarized microscopy to evaluate the presence and type of crystals., Results: Compensated polarized microscopy revealed both monosodium urate (MSU) and calcium pyrophosphate dihydrate (CPPD) crystals extracted from the knee joint., Conclusions: Our findings suggest that the coexistence of gout and pseudogout should be considered in the diagnosis of crystal-induced arthritis. Careful crystal evaluation using compensated polarized microscopy may reveal similar cases with MSU and CPPD crystals in the same joint.

We report a case of CPPD crowned dens syndrome in an 87 year white old male with a known history of pseudogout, with clinical and radiological features characteristic of this syndrome. Interestingly, there was significant mass effect on the clivus, with clivus erosion and destruction, a finding that has not previously been described with this syndrome. The clinical and radiological characteristics of Crowned Dens syndrome, as well as CPPD are reviewed. We suggest that CPPD crowned dens syndrome may be included in the differential diagnosis when clivus destruction or erosion, in association with a soft tissue mass with calcification, is seen.

Background: Pseudogout of the temporomandibular joint (TMJ) is a rare disorder with <40 reported cases in the English-language literature. It is usually treated with surgical resection and condylectomy alone., Methods: We report the case of a 68-year-old woman presenting with a preauricular mass resulting from calcium pyrophosphate deposition (pseudogout) in the TMJ, who underwent surgical resection with immediate reconstruction., Results: Open surgical resection to completely remove the mass confirmed substantial erosion of the condyle and disc, necessitating condylectomy and discectomy. The joint was thereafter immediately reconstructed by total joint arthroplasty using a Christensen TMJ implant sized to the patient's anatomy. The patient was able to resume a regular diet and demonstrated marked improvement in her interincisal opening., Conclusion: Immediate reconstruction of the TMJ with total joint arthroplasty is a safe and effective measure following removal of this (and potentially other) TMJ lesions.

Background: The infratemporal fossa is a well-concealed, complex anatomical space. Neoplasms arising in this area are heterogenous in nature and have an insidious onset and usually present late., Methods and Results: We present a case of a 71-year-old woman who presented with worsening facial pain, trismus, and a large mass in her infratemporal fossa with minimal associated temporomandibular joint destruction. She underwent a surgical excision of the mass, which revealed a pseudogout deposit., Conclusion: The clinical and radiological features of patients with tophaceous pseudogout frequently mimic those of a benign or malignant neoplasm of the infratemporal fossa, often resulting in more radical surgery.

Patients with preauricular masses present with a wide range of pathologies, the most common of which are neoplasms of the parotid gland, metastatic or inflammatory disease, and enlarged periparotid lymph nodes. Other possibilities include lesions that arise from the skull base or the temporomandibular joint (TMJ). Chondrocalcinosis is a common age-related phenomenon that has a predilection for fibrocartilage. Although it can involve any joint, the knee is by far the most common site; involvement of the TMJ is very rare. We describe a case of chondrocalcinosis of the TMJ that manifested as a preauricular swelling and mimicked a parotid tumor, and we discuss the pathophysiology and radiographic characteristics of this disease.

Calcium pyrophosphate dihydrate (CPPD) deposits are frequently observed in joint tissues. They can also occur in other tissues and present as a tophus. Contrarily to gout, a CPPD tophus is exceptionally localized in a finger. This presentation concerns a 81-year-old man who developed a huge tumor-like tophus of CPPD crystals on the antero-lateral side of his 3rd right finger, reducing superficial sensibility and eroding the proximal phalanx. Similarly to the majority of the rare previous reported cases, there was no associated chondrocalcinosis and the diagnosis was only made by the histological examination of the resected tissues. Better knowledge of this entity could avoid enlarged surgery as it has been done on some occasion.

A 5-year-old painted turtle (Chrysemys picta) presented with a 1cm nodular enlargement of the right femorotibial joint. The right leg was amputated, because the nodule continued to grow and motor problems appeared. The cut surface of the nodule was yellowish white, and had a colloidal to chalky gross appearance. Microscopically, a multinodular foreign-body granuloma was observed around the joint capsule. Morphological and histochemical examination showed that the foreign body consisted of calcium pyrophosphate. Histological findings revealed that the articular cartilage was mainly involved in the pathological onset of the disease, and was therefore diagnosed as tophaceous pseudogout. This disease is generic in elderly people, but is rare in animals. Also, there are only three reports in reptiles.

Tophaceous pseudogout is a rare manifestation of calcium pyrophosphate dihydrate (CPPD) deposition disease that particularly affects the temporomandibular joint (TMJ). We describe a case of tophaceous pseudogout and review the literature. Thirty-four cases of chronic CPPD deposition disease affecting the TMJ are described. Symptoms usually included pain and swelling. Most patients required surgery because of extensive crystal deposits, usually localized to the joint and adjacent structures but occasionally invasive. For many patients, malignancy was the preoperative diagnosis. Although patients with acute pseudogout of the TMJ may have involvement of other joints, tophaceous pseudogout was predominantly isolated to the TMJ.

Object: Calcium pyrophosphate dihydrate (CPPD) deposition is a rare cause of retroodontoid mass lesions in elderly individuals. However, this condition may be severely underdiagnosed if sufficient attention is not paid to imaging characteristics and clinical presentation. The authors sought to evaluate the decision-making process in both the diagnosis and surgical treatment of CPPD., Methods: A retrospective review of University of Iowa medical records and radiographs accumulated between 1977 and 2006 was performed. The inclusion criterion was histopathological findings consistent with pseudogout at the craniovertebral junction (CVJ). Twenty-one patients with a mean age of 70.3 years and a mean symptom duration prior to presentation of 17.5 months were identified and included in this study., Results: The patients presented most frequently with occipital and neck pain (85%) and numbness or paresthesias (61%). Lower cranial nerve deficits were seen in 29%. Calcification of the mass or transverse ligament was seen on computed tomography in all included patients. Gross-total resection was achieved in all patients: 19 of 21 patients underwent transoral-transpalatopharyngeal resection, with only 16 requiring concomitant dorsal occipital-cervical fusion. The mean follow-up duration was 15 months. Eighteen patients (86%) had improvement or resolution of symptoms after treatment, and 3 were lost to follow-up., Conclusions: Although rare, CPPD deposition at the CVJ should be suspected on finding calcification of and around the transverse ligament on neuroimaging. Transoral-transpalatopharyngeal resection is preferred to halt the progression of neurological deterioration; dorsal fusion is not always mandatory as concomitant ligamentous calcification and atlantoaxial joint ankylosis may provide added stability.

A 75-year-old male presented with progressive myelopathy due to massive retro-odontoid deposits of calcium pyrophosphate dehydrate (CPPD) crystals. Magnetic resonance imaging revealed a non-enhanced isointense extradural mass on a T1-weighted image and a heterogeneous intense mass on a T2-weighted image. Computed tomography (CT) showed linear calcification within the mass. The mass was resected via a posterolateral approach resulting in marked improvement of the symptoms. Histological examination revealed birefringent rhomboid crystals consistent with CPPD. The preoperative differential diagnosis of periodontoid CPPD deposition disease in the elderly population should be considered, particularly if CT studies demonstrate small areas of calcification within the retro-odontoid mass.

Objective: To describe a rare case of tumoral cervical chondrocalcinosis that appeared 28 years after the patient had undergone suboccipital craniotomy., Clinical Presentation: A 42-year-old woman suffered from cervicalgia associated with a firm mass at the occipitocervical region. Plain x-ray and computed tomographic and magnetic resonance images revealed a calcified lesion in a scar from a previous suboccipital craniotomy., Intervention: The patient underwent tumorectomy and histopathology, which revealed an exuberant tumoral chondrocalcinosis. Laboratory test results revealed no secondary cause for the chondrocalcinosis., Conclusion: Identification of chondrocalcinosis beyond the cervical region is very rare. Localization of chondrocalcinosis in a scar from a previous suboccipital craniotomy has not been previously reported. Surgery appears to be the treatment of choice for this form of chondrocalcinosis.