case_images: PMC4298813_01
case_images: Gout affecting the joints of the left hand.
case_images: TOORTHJ-8-482_F1.jpg
case_images: PMC4298813_01_TOORTHJ-8-482_F1.jpg
case_images: F1
case_images: Joints affected by the gout included the knees, elbows, ankles and small joints of the hands (see Figs. 1, 2).
case_images: Joints of the patient's feet demonstrate gouty tophi.
case_images: TOORTHJ-8-482_F2.jpg
case_images: PMC4298813_01_TOORTHJ-8-482_F2.jpg
case_images: F2
case_images: Joints affected by the gout included the knees, elbows, ankles and small joints of the hands (see Figs. 1, 2).
case_images: Exudate expressed from left knee at initial arthroscopic
  washout.
case_images: TOORTHJ-8-482_F3.jpg
case_images: PMC4298813_01_TOORTHJ-8-482_F3.jpg
case_images: F3
case_images: The chalky, gritty accumulations of monosodium urate crystals were expressed followed by a thorough washout (see Figs. 3, 4).
case_images: Debridement and washout of the left knee.
case_images: TOORTHJ-8-482_F4.jpg
case_images: PMC4298813_01_TOORTHJ-8-482_F4.jpg
case_images: F4
case_images: The chalky, gritty accumulations of monosodium urate crystals were expressed followed by a thorough washout (see Figs. 3, 4).
case_images: Intra-articular portals to enable access to the joint space.
case_images: TOORTHJ-8-482_F5.jpg
case_images: PMC4298813_01_TOORTHJ-8-482_F5.jpg
case_images: F5
case_images: On day 26 of admission, a further joint debridement and washout was undertaken and three intra-articular portals were established based on previous incisions (see Fig. 5).
case_images: V.A.C. VeraFlo  negative pressure equipment.
case_images: TOORTHJ-8-482_F6.jpg
case_images: PMC4298813_01_TOORTHJ-8-482_F6.jpg
case_images: F6
case_images: C-reactive protein (CRP) trend with surgical intervention.
case_images: TOORTHJ-8-482_G1.jpg
case_images: PMC4298813_01_TOORTHJ-8-482_G1.jpg
case_images: G1
case_images: By day 53 of admission, four weeks after attachment of topical negative pressure device, the extent of healing of the three incisions meant that the instillations were no longer penetrating to the joint space (see Fig. 7).
case_images: Left knee after V.A.C. VeraFlo  therapy.
case_images: TOORTHJ-8-482_F7.jpg
case_images: PMC4298813_01_TOORTHJ-8-482_F7.jpg
case_images: F7
case_images: Able to mobilise independently18 months post discharge.
case_images: TOORTHJ-8-482_F8.jpg
case_images: PMC4298813_01_TOORTHJ-8-482_F8.jpg
case_images: F8