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HPI
An 83-year-old female with a known history of metastatic renal cell carcinoma presented with acute onset right knee pain following a low-energy incident (while walking indoors). She experienced a sudden inability to bear weight.
PMH
Metastatic renal cell carcinoma (diagnosed 3 years ago) Hypertension Osteopenia
PE
Moderate swelling and ecchymosis over the proximal tibia and knee area. No open wounds. Tenderness to palpation over the tibial plateau and anterior proximal tibia. Distal tibia mildly tender to deep palpation. Severely limited knee movement due to pain (0–15° passively). Cannot perform active straight leg raise; limited secondary to pain. Sensation intact to light touch in peroneal, tibial, and saphenous distributions. Dorsalis pedis and posterior tibial pulses palpable and symmetric. Non-ambulatory; requires assistance for transfers
proximal tibial replacement, including reconstruction of the patellar tendon with mesh and McLaughlin technique and cement augmentation of the distal tibia.
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