Posted: Jan 10 2022 #(C101934)

Knee Pain in 67F

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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

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

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%

(495/860)

Yes - additional radiographic views (i.e full limb lengths, aXR)

31%

(268/860)

Yes - CT scan of the knee (CT)

(31/860)

Yes - MRI of the knee (MRI)

(26/860)

Yes - aXR + CT

(7/860)

Yes - aXR + MRI

(8/860)

Yes - CT + MRI

(6/860)

Yes - aXR + CT + MRI

(6/860)

Outside my area of expertise - best if I don't vote

(13/860)

How would you manage the patient at this time?

Nonoperative

(25/850)

Operative

96%

(818/850)

Outside my area of expetise - best if I don't vote

(7/850)

If you choose Operative management, what surgery would you perform?

I would not choose Operative management

(6/842)

Arthroscopy only (with interventions as indicated)

(7/842)

Osteotomy (i.e high tibial osteotomy)

(9/842)

Arthroplasty

95%

(808/842)

Arthrodesis

(3/842)

Outside my area of expertise - best if I don't vote

(9/842)

If you choose Arthroplasty, what procedure would you perform?

I would not choose Arthroplasty

(2/847)

Unicompartmental arthroplasty (UKA)

(7/847)

Bicompartmental knee arthroplasty (BKA) (e.g. "Deuce")

(15/847)

Total knee arthroplasty (TKA)

95%

(809/847)

Outside my area of expertise - best if I don't vote

(14/847)

If you choose TKA, what prosthesis design would you plan to utilize?

I would not choose TKA

(4/832)

Cruciate retaining (CR)

33%

(278/832)

Posterior cruciate sacrificing (PS)

50%

(416/832)

Varus-valgus constrained (VVC)

(54/832)

Hinged

(21/832)

Outside my area of expertise - best if I don't vote

(59/832)

If you choose TKA, would you plan on using technology?

I would not choose TKA

(4/812)

56%

(462/812)

Yes - Navigation

11%

(91/812)

Yes - Robotic assisted

11%

(96/812)

Yes - Patient Specific Instrumentation (PSI)

(60/812)

Yes - Sensors

(3/812)

Yes - Combination of above

(37/812)

Outside my area of expertise - best if I don't vote

(59/812)

If you choose TKA, would you utilize a tourniquet?

I would not choose TKA

(3/807)

16%

(136/807)

Yes - but only during cementation

18%

(146/807)

Yes - for the entire case

60%

(486/807)

Outside my area of expertise - best if I don't vote

(36/807)

If you choose TKA, what type of bearing design would you use?

I would not choose TKA

(0/782)

Mobile (rotating platform)

11%

(91/782)

Traditional fixed bearing

69%

(542/782)

Medial-pivot fixed bearing

11%

(92/782)

Outside my area of expertise - best if I don't vote

(57/782)

If you choose TKA, what fixation strategy would you utilize?

I would not choose TKA

(0/790)

Cement - all components

78%

(620/790)

Press-fit - all components

(48/790)

Hybrid (cemented + press-fit)

11%

(88/790)

Outside my area of expertise - best if I don't vote

(34/790)

If you choose TKA, would you plan on resurfacing the patella?

I would not choose TKA

(0/787)

23%

(183/787)

Yes

54%

(431/787)

Selective resurfacing depending on intraoperative findings

19%

(153/787)

Outside my area of expertise - best if I don't vote

(20/787)

If you choose TKA, what chemical anticoagulation would you use postoperatively?

I would not choose TKA

(0/787)

None

(2/787)

Aspirin (any dose)

33%

(262/787)

Low molecular weight heparin (ie. Lovenox)

42%

(338/787)

Direct factor Xa inhibitors (ie. Rivaroxaban, Apixaban, Fondaparinux, etc.)

20%

(159/787)

Warfarin (ie. Coumadin)

(8/787)

Outside my area of expertise - best if I don't vote

(18/787)

Post-procedure P1

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