Doctor, There's Something Wrong With My Knee Replacement - Page #1
 

Author: Peter MacArthur, MD
Co Author #1: Peter H MacArthur, MD
Co Author #2: Thomas Fleeter, MD
Co Author #3: Garry Ho, MD
Editor: Jason Eggers, MD, DC

Patient Presentation:
A 77 year old female with a history of total replacement of her left knee in 2007 presented with a five day history of progressively worsening left knee pain. She described her pain as anterior, stabbing, and constant. It was moderate in intensity, worse with ambulation, and improved slightly with rest. There was no history of trauma or other known mechanism of injury. She denied locking, weakness, instability, swelling, radiation of pain, or fever. A complete review of systems was otherwise negative.

History:
Her past medical history was significant for coronary artery disease, congestive heart failure, hyperlipidemia, gastroesophageal reflux disease, gout, and osteoarthritis. In addition to her knee replacement, her past surgical history also included coronary stent placement in 2007 and aortic valve replacement in 2013. Her medications included bisoprolol fumarate, apixaban, ranitidine, Nitrostat, lansoprazole, baby aspirin, calcium carbonate, vitamin D, rosuvastatin, furosemide, and potassium chloride. Her family history was non-contributory. She denied alcohol abuse and does not smoke.

Physical Exam:
Physical exam revealed an obese female with an antalgic gait. Vital signs were normal. Her left knee showed no overlying skin changes or appreciable deformity. She had mild swelling and trace effusion. Her alignment was neutral. There was no tenderness to palpation. Active and passive ranges of motion were both 0-130 degrees and strength was normal. Her neurovascular exam showed normal sensation, reflexes, and distal pulses. Ligamentous evaluation, special tests, and the rest of the exam were normal.

Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.


NOTE: For more information, please contact the AMSSM, 11639 Earnshaw, Overland Park, KS 66210, (913) 327-1415.
 

© The American Medical Society for Sports Medicine
4000 W. 114th Street, Suite 100
Leawood, KS 66211
Phone: 913.327.1415


Website created by the computer geek