title: A rare cause of arthropathy: An ochronotic patient with black joints.
abstract: BACKGROUND
  Alkaptonuria is an autosomal recessive disorder of metabolism. The pathogenesis of alkaptonuria includes chronic inflammation, degeneration, and eventually osteoarthritis. Ochronotic arthropathy is a rare condition found in patients with alkaptonuria.
  
  
  METHODS
  A 60-year-old female presented for evaluation after a 10-year history of low back pain, right hip pain, and bilateral knee pain. A cementless right total hip and a cemented left knee replacement were performed. Intraoperatively, the joint surfaces, neighboring ligaments, and tendons were black with pieces of black cartilage tissue. Histological sections of bone and soft tissue demonstrated classic findings of ochronosis, including multiple pigmented areas, reactive giant cells, and a thickened, inflamed synovium.
  
  
  CONCLUSIONS
  The management of ochronotic arthropathy in alkaptonuria patients is usually conservative, but replacement surgery is offered for severely affected hip and knee joints. A few reports of the surgical treatment of ochronotic arthropathy have been published. This report describes a case of ochronotic hip and knee arthritis treated with total hip and knee arthroplasties.
  
  
  CONCLUSIONS
  Joint replacement has excellent outcomes in a patient with significant degenerative arthropathy due to ochronosis.
authors.affiliation: Department of Orthopaedics, Taksim Training and Research Hospital, Karayollari Mahallesi, Osmanbey Caddesi, No. 120, 34255 Gaziosmanpasa, Istanbul, Turkey. Electronic address: drharunmutlu@yahoo.com.
authors.forename: Mutlu
authors.initials: M
authors.lastname: Harun
authors.affiliation: Department of Orthopaedics, Taksim Training and Research Hospital, Karayollari Mahallesi, Osmanbey Caddesi, No. 120, 34255 Gaziosmanpasa, Istanbul, Turkey. Electronic address: hayriyaldiz@yahoo.com.
authors.forename: Yaldız
authors.initials: Y
authors.lastname: Hayrettin
authors.affiliation: Department of Orthopaedics, Kanuni Sultan Suleyman Training and Research Hospital, Altınşehir, Turgut Özal Cd. No. 1, 34303 Kucukcekmece, Istanbul, Turkey. Electronic address: serhatmutlu@hotmail.com.
authors.forename: Mutlu
authors.initials: M
authors.lastname: Serhat
authors.affiliation: Department of Orthopaedics, Taksim Training and Research Hospital, Karayollari Mahallesi, Osmanbey Caddesi, No. 120, 34255 Gaziosmanpasa, Istanbul, Turkey. Electronic address: cuneytmay@gmail.com.
authors.forename: May
authors.initials: M
authors.lastname: Cuneyt
authors.affiliation: Department of Orthopaedics, Taksim Training and Research Hospital, Karayollari Mahallesi, Osmanbey Caddesi, No. 120, 34255 Gaziosmanpasa, Istanbul, Turkey. Electronic address: drfiratfidan@gmail.com.
authors.forename: Fidan
authors.initials: F
authors.lastname: Fırat
authors.affiliation: Department of Orthopaedics, Taksim Training and Research Hospital, Karayollari Mahallesi, Osmanbey Caddesi, No. 120, 34255 Gaziosmanpasa, Istanbul, Turkey. Electronic address: ufukozkaya2004@yahoo.com.
authors.forename: Ozkaya
authors.initials: O
authors.lastname: Ufuk
keywords: Alkaptonuria; Black cartilage; Joint replacement; Ochronosis