We present a patient with gout and a total knee arthroplasty that failed secondary to infection. The English literature records only 5 other cases of gouty attacks after total knee arthroplasty. Symptoms, presentation, and laboratory tests do not definitively differentiate between infection and gout, but crystals in the joint aspirate are diagnostic. This case stresses the importance of recognizing crystalline arthropathy as a source of a painful knee and as a complicating factor during revision surgery.
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