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Knee Osteoarthritis
Posted: Jan 10 2022 #(C101934)
A

Knee Pain in 67F

HPI

A 67-year-old female presents with long-standing left knee pain and valgus deformity. She reports pain that interferes with her life daily. Previously, she enjoyed taking long walks with her husband, which she can no longer do due to knee pain. She has failed conservative measures including a corticosteroid injection 4 months ago and several months of PT. She previously underwent a right TKA with a separate surgeon and she is very happy with the results of that prior operation.

PMH

PMH: HTN PSH: right TKA

PE

Obese female with a BMI of 31. Focused exam of the left lower extremity reveals minor valgus malalignment of the left knee with a small effusion. She is tender to palpation about the medial and lateral joint lines. Lacks 5 degrees of full extension, flexes back to 120 degrees. There is obvious crepitance with ROM. Knee stable to varus and valgus stress. She is neurovascularly intact.

Poll
1 of 11
1. In addition to plain film radiographs of the knee, would you obtain further imaging to guide management?
No - additional imaging would not change my management
57%
514/892
Yes - additional radiographic views (i.e full limb lengths, aXR)
31%
278/892
Yes - CT scan of the knee (CT)
3%
32/892
Yes - MRI of the knee (MRI)
2%
26/892
Yes - aXR + CT
0%
7/892
Yes - aXR + MRI
0%
8/892
Yes - CT + MRI
0%
6/892
Yes - aXR + CT + MRI
0%
6/892
Outside my area of expertise - best if I don't vote
1%
15/892
2. How would you manage the patient at this time?
Nonoperative
2%
26/880
Operative
96%
845/880
Outside my area of expetise - best if I don't vote
1%
9/880
3. If you choose Operative management, what surgery would you perform?
I would not choose Operative management
0%
6/871
Arthroscopy only (with interventions as indicated)
0%
8/871
Osteotomy (i.e high tibial osteotomy)
1%
9/871
Arthroplasty
95%
834/871
Arthrodesis
0%
3/871
Outside my area of expertise - best if I don't vote
1%
11/871
4. If you choose Arthroplasty, what procedure would you perform?
I would not choose Arthroplasty
0%
2/874
Unicompartmental arthroplasty (UKA)
0%
7/874
Bicompartmental knee arthroplasty (BKA) (e.g. "Deuce")
1%
16/874
Total knee arthroplasty (TKA)
95%
833/874
Outside my area of expertise - best if I don't vote
1%
16/874
5. If you choose TKA, what prosthesis design would you plan to utilize?
I would not choose TKA
0%
4/860
Cruciate retaining (CR)
33%
290/860
Posterior cruciate sacrificing (PS)
50%
430/860
Varus-valgus constrained (VVC)
6%
54/860
Hinged
2%
21/860
Outside my area of expertise - best if I don't vote
7%
61/860
6. If you choose TKA, would you plan on using technology?
I would not choose TKA
0%
4/839
No
56%
476/839
Yes - Navigation
11%
93/839
Yes - Robotic assisted
12%
102/839
Yes - Patient Specific Instrumentation (PSI)
7%
61/839
Yes - Sensors
0%
3/839
Yes - Combination of above
4%
39/839
Outside my area of expertise - best if I don't vote
7%
61/839
7. If you choose TKA, would you utilize a tourniquet?
I would not choose TKA
0%
3/834
No
17%
143/834
Yes - but only during cementation
18%
152/834
Yes - for the entire case
59%
498/834
Outside my area of expertise - best if I don't vote
4%
38/834
8. If you choose TKA, what type of bearing design would you use?
I would not choose TKA
0%
0/809
Mobile (rotating platform)
11%
93/809
Traditional fixed bearing
69%
560/809
Medial-pivot fixed bearing
11%
94/809
Outside my area of expertise - best if I don't vote
7%
62/809
9. If you choose TKA, what fixation strategy would you utilize?
I would not choose TKA
0%
0/815
Cement - all components
78%
638/815
Press-fit - all components
6%
52/815
Hybrid (cemented + press-fit)
10%
89/815
Outside my area of expertise - best if I don't vote
4%
36/815
10. If you choose TKA, would you plan on resurfacing the patella?
I would not choose TKA
0%
0/812
No
23%
187/812
Yes
54%
444/812
Selective resurfacing depending on intraoperative findings
19%
159/812
Outside my area of expertise - best if I don't vote
2%
22/812
11. If you choose TKA, what chemical anticoagulation would you use postoperatively?
I would not choose TKA
0%
0/812
None
0%
2/812
Aspirin (any dose)
33%
271/812
Low molecular weight heparin (ie. Lovenox)
42%
348/812
Direct factor Xa inhibitors (ie. Rivaroxaban, Apixaban, Fondaparinux, etc.)
20%
163/812
Warfarin (ie. Coumadin)
0%
8/812
Outside my area of expertise - best if I don't vote
2%
20/812
PROCEDURE #1

Left cemented, standard instrumentation (non-robotic) posterior-stabilized total knee arthroplasty

icon
OUTCOMES
Post-procedure P1
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