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Removal of Gouty Tophi
Removal of gouty tophi treats chalky deposits of uric acid crystals that build up in and around the joints of the fingers and hand in people with long-standing gout. Surgical excision removes these deposits to relieve pain, restore joint movement, and address deposits that have become infected, ulcerated, or are compressing surrounding tissue.
At a glance
Anaesthetic
Local anaesthetic, sedation or general anaesthetic at hospital, depending on the extent of tophi and whether joints are involved
Where
The Avenue Hospital
Day case or overnight
Day case - home the same day
First post operative review
Approximately one week after surgery
Driving
Plan not to drive for one to two weeks.
Post Operative Hand Therapy
Recommended
Splinting
Often recommended depending on the location of surgery and proximity to a joint
Pain relief
Usually paracetamol and/or ibuprofen
Return to repetitive & heavy loading
Days to weeks depending on the extent of surgery
Surgical removal of uric acid deposits (tophi) affecting the hand
Removal of gouty tophi is surgery to excise deposits of uric acid crystals (tophi) that have built up in and around the joints and tendons of the hand, distorting the fingers or affecting joint and tendon function.
Who is this procedure for?
- People with chronic gout who have visible or palpable tophi distorting a finger or joint
- People whose tophi are affecting joint movement, tendon gliding, or causing skin breakdown
- People with tophi-related trigger finger, trigger thumb, or carpal tunnel syndrome not settling with medical treatment
- Not a substitute for medical treatment of gout, which must continue under your treating physician
What does the surgery involve?
Surgery involves an incision over the affected area to expose and excise the chalky, uric-acid-laden tophaceous material. If a tendon (causing trigger finger or trigger thumb) or nerve (causing carpal tunnel syndrome) is affected by the deposits, this is released or decompressed at the same time. The wound is closed and a dressing applied.
Alternatives to surgery
Removal of gouty tophi is one option once medical treatment alone has not resolved the problem. Surgery for gouty tophi is reserved for severe, uncontrolled cases where deposits cause persistent pain, joint damage, or complications such as trigger finger or carpal tunnel syndrome. With effective medical management of gout, uric acid levels can ideally be controlled well enough that these deposits never form or progress to the point where surgery is needed at all. Depending on your situation, the alternatives may include:
- Doing nothing for now (watchful waiting): reasonable if tophi are small, not painful and not affecting function
- Non-surgical management: optimising urate-lowering medical therapy under your physician, which can shrink tophi over time and is the mainstay of treatment
- A different procedure: if a tendon or nerve is affected, this may be treated as trigger finger release or carpal tunnel release rather than tophi excision alone
What happens if left untreated: tophi can continue to enlarge, distort the finger, restrict movement, and in some cases cause skin breakdown or joint destruction.
Dr Tomlinson will discuss which options suit you at your consultation, in conjunction with your treating physician.
Frequently Asked Questions
Where will my surgery be done?
At the Avenue Hospital.
Why might I choose local anaesthetic rather than sedation or a general anaesthetic?
A procedure under local anaesthetic avoids the risks and recovery of sedation or a general anaesthetic. You don’t need to fast beforehand, you can eat and drink normally, you recover quickly, and you usually go home soon afterwards. For many people it’s also less expensive and more convenient. For some procedures, local anaesthetic alone is not an option – in that case Dr Tomlinson will advise you of this at your consultation
How much time will I need to have away from work?
This depends on what your job involves and how extensive the tophi removal is. If your work is desk-based or administrative, you may be able to return relatively soon, often with some temporary modifications. If your work is physical – heavy lifting, manual labour or “on tools” – you’ll usually need longer. Dr Tomlinson will give you advice tailored to your job at your consultation.
When will I be able to drive again?
Multiple things affect this: which hand was treated, whether you’re wearing a bandage, whether you can grip the wheel and respond safely in an emergency, whether you are driving for personal or commercial purposes, the nature of the vehicle you are driving, and your pain levels and medications. You also need to be safely in control of the vehicle for insurance purposes – you should be able to grip the steering wheel strongly with both hands and be able to take evasive action in an emergency before you get behind the wheel. As a guide: plan not to drive for one week after the procedure.
When can I do a full day of administrative or desk work?
Often from 1 week after surgery, particularly with some temporary adjustments (see below). Keeping your hand elevated and taking regular breaks helps reduce swelling and discomfort in the early days. If you need to drive to work or carry or lift objects as part of your administrative work then alternate or half days may be a prudent measure when first returning to work.
What workplace modifications might help?
Depending on your job, helpful temporary modifications can include:
– Half days or alternate days to begin with
– No heavy lifting
– Lighter duties or being off tools
– More frequent breaks
– Using a headset instead of holding a phone
– Voice-to-text or dictation instead of typing
– Keeping the hand elevated at your workstation
– Avoiding repetitive gripping
– Help with carrying or moving items
– Moving temporarily to reception or phone duties if your role is normally manual
– Protecting the wound if your work exposes your hands to water or contamination (e.g. food handling, healthcare, wet trades)
We’re happy to provide a letter for your employer outlining recommended modifications.
I take a GLP-1 medication (such as Ozempic, Wegovy, Mounjaro or Trulicity) — how does this affect my procedure?
GLP-1 medications, used for diabetes or weight management, slow the emptying of the stomach. This can increase the risk of stomach contents being present during sedation or a general anaesthetic. In line with current ANZCA guidance, if you’re having sedation or a general anaesthetic you’ll be asked to follow a clear-fluid-only diet for 24 hours before your procedure, followed by the standard 6-hour fast. Please tell us and your anaesthetist that you take this medication — your anaesthetist will give you specific instructions. If your procedure is under local anaesthetic only, fasting is generally not required, but please still let us know.
How long will I need to wear a splint?
Splint recommendations are made by Dr Tomlinson and are based on the location of your surgery. Dr Tomlinson will advise you at your consultation.
Will I need to see a hand therapist afterwards? May I see one if I'd like?
If a tendon or joint was involved, hand therapy is an important part of your recovery, and Dr Tomlinson will give you a referral. For tophi removal alone, it isn’t always essential, but you’re welcome to see a hand therapist if you’d find it helpful.
What pain medication will I need afterwards?
Usually simple pain relief – paracetamol and ibuprofen – is all that’s needed. Some procedures are more uncomfortable and you may need stronger pain relief. We can always prescribe stronger painkillers if you need them.
Risks & complications
General risks of hand surgery
- Bleeding and bruising; rarely, a collection of blood (haematoma) that may need draining
- Infection, which may require antibiotics or, rarely, further surgery
- Pain — usually temporary, occasionally persistent
- Swelling – common, and usually settles over weeks to months
- Scarring – scars are permanent and occasionally become thickened, raised or sensitive
- Allergic reaction to the local anaesthetic, antiseptic, dressings, tape or suture material
- Delayed or problematic wound healing
- Stiffness or reduced movement in the fingers, hand or wrist
- Injury to nerves, causing numbness, altered sensation or, rarely, a painful neuroma
- Injury to blood vessels (arteries)
- Injury to tendons
- Injury to bone (fracture)
- Failure to fully relieve your symptoms, or symptoms returning over time (recurrence)
- Complex regional pain syndrome (CRPS) – an uncommon but significant condition causing ongoing pain, stiffness and swelling
- Cold intolerance – the hand becoming more sensitive to cold, usually improving with time
- The need for further surgery
- Blood clots in the leg or lung (DVT/PE) – uncommon in hand surgery, with a slightly higher risk after a general anaesthetic or prolonged immobilisation
Specific risks of this surgery
- Delayed wound healing, since the skin overlying tophi is often thinned or compromised by the deposits beneath it
- Infection, given the chalky material being removed
- A gout flare, which can be clinically indistinguishable from infection and so will generally warrant hospital admission and surgery to wash out the area and take swabs for bacteria
- Injury to nearby tendons or blood vessels during removal of deposits that surround them
- Further gout flares or new tophi if the underlying gout is not well controlled with medication after surgery
- Need for additional procedures, such as tendon repair or skin flap coverage, in more extensive cases
Anaesthetic
If you are having sedation or a general anaesthetic for this procedure, your anaesthetist will discuss the specific risks of anaesthesia with you separately.
Recovery & rehabilitation
First 48 hours
Keep your hand elevated for 48 hours to reduce bleeding and post-operative swelling. Local anaesthetic lasts 6–24 hours (occasionally 1–3 days); your hand will have numb areas during this time.
First week
Keep the dressing dry and intact until your post-operative review. You may use your hand for light activities, but listen to your hand and do not perform activities that cause discomfort. After the first two days you should find that your hand discomfort lessens each day.
Second week
Continue to protect the wound and avoid strong forces or knocks to the area. If the incision is in an area where movement will stretch the incision or surrounding skin tight then you will need to wear a splint made by a hand therapist to protect this area while returning to usual activities as able. If the incision is healing well then you can wash it normally in a sink or shower.
6 weeks
Full grip strength may take several months to return, and deep-pressure tenderness over the wound can persist for some months. The scar may feel tight and firm. Massage assists with improving scar mobility and minimising scar firmness.
3 months
The scar firmness will start to resolve after 3 months, and will take up to 12 months to settle.
Long term
Ongoing control of blood uric acid levels with your physician is essential to prevent new tophi forming. Joint damage from long-standing tophi will not reverse even after successful surgery.
Want to know more about Removal of Gouty Tophi?
Contact us to schedule an appointment with Dr Tomlinson.
Fees and costs
You will receive a written financial quotation after your consultation, once your operation and any third-party requirements are confirmed. See our Fees and informed financial consent page for how our fees work, what your quotation includes, and the resources available to you.