Treatment of atypical gouty arthritis of the hip using total hip arthroplasty

Rationale: Gout and gouty arthritis typically involve peripheral and monoarticular joints, especially the first metatarsophalangeal joint and knees. Hip involvement in patients with gout is rare, and its diagnosis is very difficult, especially in the late stages of the disease. Total hip arthroplasty could be a surgical treatment for atypical gouty arthritis of the hip; however, few cases have been reported. Patient concerns: We reported an uncommon case of a 74-year-old man without typical symptoms of hip gout arthritis whom was misdiagnosed as having avascular necrosis of the femoral head. Diagnoses: Clinical examination and imaging revealed bilateral avascular necrosis of the femoral head. However, the final pathology report revealed left hip gout arthritis. Interventions: The patient underwent left total hip arthroplasty and was followed up for 3years. Outcomes: The outcome was favorable. The function of the left hip was almost normal. Lessons: Our case indicated the difficulty of the diagnosis of hip gout arthritis. Due to the lower rates of hip gout arthritis and lack of typical clinical examination, it is easy to misdiagnose. Furthermore, surgical treatment for the late stage of hip gout arthritis has not previously been reported. In our case, total hip arthroplasty proved to be a good option.