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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%
515/893
Yes - additional radiographic views (i.e full limb lengths, aXR)
31%
278/893
Yes - CT scan of the knee (CT)
3%
32/893
Yes - MRI of the knee (MRI)
2%
26/893
Yes - aXR + CT
0%
7/893
Yes - aXR + MRI
0%
8/893
Yes - CT + MRI
0%
6/893
Yes - aXR + CT + MRI
0%
6/893
Outside my area of expertise - best if I don't vote
1%
15/893
2. How would you manage the patient at this time?
Nonoperative
2%
26/881
Operative
96%
846/881
Outside my area of expetise - best if I don't vote
1%
9/881
3. If you choose Operative management, what surgery would you perform?
I would not choose Operative management
0%
6/872
Arthroscopy only (with interventions as indicated)
0%
8/872
Osteotomy (i.e high tibial osteotomy)
1%
9/872
Arthroplasty
95%
835/872
Arthrodesis
0%
3/872
Outside my area of expertise - best if I don't vote
1%
11/872
4. If you choose Arthroplasty, what procedure would you perform?
I would not choose Arthroplasty
0%
2/875
Unicompartmental arthroplasty (UKA)
0%
7/875
Bicompartmental knee arthroplasty (BKA) (e.g. "Deuce")
1%
16/875
Total knee arthroplasty (TKA)
95%
834/875
Outside my area of expertise - best if I don't vote
1%
16/875
5. If you choose TKA, what prosthesis design would you plan to utilize?
I would not choose TKA
0%
4/861
Cruciate retaining (CR)
33%
290/861
Posterior cruciate sacrificing (PS)
49%
430/861
Varus-valgus constrained (VVC)
6%
54/861
Hinged
2%
21/861
Outside my area of expertise - best if I don't vote
7%
62/861
6. If you choose TKA, would you plan on using technology?
I would not choose TKA
0%
4/840
No
56%
476/840
Yes - Navigation
11%
93/840
Yes - Robotic assisted
12%
102/840
Yes - Patient Specific Instrumentation (PSI)
7%
61/840
Yes - Sensors
0%
3/840
Yes - Combination of above
4%
39/840
Outside my area of expertise - best if I don't vote
7%
62/840
7. If you choose TKA, would you utilize a tourniquet?
I would not choose TKA
0%
3/835
No
17%
143/835
Yes - but only during cementation
18%
152/835
Yes - for the entire case
59%
498/835
Outside my area of expertise - best if I don't vote
4%
39/835
8. If you choose TKA, what type of bearing design would you use?
I would not choose TKA
0%
0/810
Mobile (rotating platform)
11%
93/810
Traditional fixed bearing
69%
560/810
Medial-pivot fixed bearing
11%
94/810
Outside my area of expertise - best if I don't vote
7%
63/810
9. If you choose TKA, what fixation strategy would you utilize?
I would not choose TKA
0%
0/816
Cement - all components
78%
639/816
Press-fit - all components
6%
52/816
Hybrid (cemented + press-fit)
10%
89/816
Outside my area of expertise - best if I don't vote
4%
36/816
10. If you choose TKA, would you plan on resurfacing the patella?
I would not choose TKA
0%
0/813
No
23%
187/813
Yes
54%
444/813
Selective resurfacing depending on intraoperative findings
19%
160/813
Outside my area of expertise - best if I don't vote
2%
22/813
11. If you choose TKA, what chemical anticoagulation would you use postoperatively?
I would not choose TKA
0%
0/813
None
0%
2/813
Aspirin (any dose)
33%
271/813
Low molecular weight heparin (ie. Lovenox)
42%
349/813
Direct factor Xa inhibitors (ie. Rivaroxaban, Apixaban, Fondaparinux, etc.)
20%
163/813
Warfarin (ie. Coumadin)
0%
8/813
Outside my area of expertise - best if I don't vote
2%
20/813
PROCEDURE #1

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

icon
OUTCOMES
Post-procedure P1
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