Arthroplasty in Ochronotic Arthropathy: 3 Replacements in a Single Patient with a Long-term Follow-up of 11 Years

Introduction: Alkaptonuria is a rare autosomal recessive disorder caused by the defective metabolism of homogentisic acid, with a rare course and remained undetected even until adulthood. Ochronotic arthropathy is one of the manifestations of alkaptonuria, predominantly affecting weight bearing joints such as spine, hip, and knee. Total joint arthroplasty is treatment of choice in end-stage arthritis of hip and knee. Owing to the rarity of the disease, limited data is available in literature regarding surgical challenges and long-term functional outcomes. Case Report: Herein, we present a case of 43-year-old male with ochronotic arthropathy of bilateral hip, right knee, and bilateral elbow joints with involvement of spine, who was incidentally diagnosed with ochronotic arthropathy intraoperatively and underwent sequential arthroplasty for right hip followed by right knee and left hip over a period of 10 years. At 11 years’ follow-up, the patient has full mobility with no loosening of implants. Conclusion: The long-term results of total joint arthroplasty in ochronotic arthropathy are good. Surgeon should be aware of the difficulty in soft tissue balancing and possible complications in the ochronotic arthropathy and require a conscientious approach to avoid complications. Keywords: Alkaptonuria, ochronosis, ochronotic arthropathy, total knee arthroplasty, total hip arthroplasty.