To document the indications, results and complications associated with surgery for tophaceous gout in Middlemore Hospital.
A retrospective study of the notes of all patients who underwent surgery for tophaceous gout at Middlemore Hospital from July 1995 to July 2001 was performed. Serum creatinine and uric acid results were obtained and the use of allopurinol assessed.
45 patients underwent surgery for gouty tophi. 89% were males and 11% females. 16% were Maori, 38% Pacific people, 42% Europeans and 4% were from other ethnic backgrounds. Renal impairment (serum creatinine. >0.11 mmol/L) was the most common associated medical problem (38%), followed by hypertension (27%), ischaemic heart disease and/or congestive heart disease (20%) and diabetes mellitus (18%). 68% of patients had elevated serum urate levels (>0.42 mmol/L) and only 31% had previously been taking allopurinol. Sepsis control in infected or ulcerated tophi was the main indication for surgery (51%), followed by mechanical problems caused by foot, elbow and hand tophi (27%). The diagnosis of soft tissue masses was unclear in 18% of the patients prior to surgery. 4% of patients underwent tophus surgery mainly for pain control. 53% of patients experienced delayed wound healing as a result of complications of surgery with the majority of these patients (16/24, 67%) having infected or ulcerated tophi prior to surgery. Three patients (7%) required digital amputations for ongoing sepsis. 47% of patients did not have any complication of surgery and had complete wound healing within one week.
Surgery for tophaceous gout is associated with a relatively high rate of complication when sepsis is the main indication. Patients with gout in this study population had several associated medical co-morbidities, which contributed to the high complication rate. Gout control was poor as evidenced by a high rate of hyperuricaemia, and less than one third of the study population were on allopurinol. Better control of gout would reduce the risk of tophi formation and the need for surgery.