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HPI - 64 YRS 110 KG MALE PATIENT WAS OPERATED( TOTAL KNEE REPLACEMENT ) FOR RIGHT KNEE PAIN 3 MONTHS BACK. PATIENT DEVELOPED PAIN OVER THE MEDIAL SIDE OF THE KNEE AFTER 15 DAYS. PATIET IS ABLE TO WALK CLIMB STAIRS BUT COMPLAINING OF SEVERE PAIN WHILE GETTING OUT FROM CHAIR OR BED. HE HAD A HABBIT OF CROSSING LEGS WHILE SETTING. WHILE SLEEPING PT KEEPS HIS LIMB IN EXTERNAL ROTATION AND MID FLEXION ( POSITION OF EASE).
HOW TO TREAT THIS UNRESOLVED PAIN
HPI - A 67 year old patient presents complaining of a 1 year history of pain in his right knee. The pain is aggravated with walking and other activity. He notices an audible click and swelling around the right knee. The patient is 5 years status post a TKA in the same knee.
What is the most probable diagnosis?
HPI - I had done a TKR yesterday and the patient was on an epidural infusion for pain management. 6 hrs post-op, when she was unattended she got up (patient claims to have heard a knock at her room door and wanted to open the door - patient had been drowsy due to the epidural which had a mixture of local anaesthetic and narcotic) from the bed and buckled down with the knee hyperflexed and was on the floor. She had wound dehiscence and I took her to theatre immediately following the fall.
Intra-operatively, I found full thickness dehiscence and MCL substance tear close to tibial insertion was noted. The medial parapatellar tissues were partly ripped and friable. I performed an MCL repair. Since we don't stock implants, there was no chance I could go for a revision to a constrained prosthesis. I was not prepared to wait for a day leaving the wound open and at risk of an infection. I've applied a knee brace.
What is your post-op rehab protocol in this situation?