Knee Arthroplasty Case Studies

Based on the progress report dated 03/28/16 by Dr. Bakhos, the patient presents for follow-up of his right knee

Physical therapy saw the patient, and the result of the examination are as follows; 6/10 left knee pain at rest and during activity (0 no pain, 10 worst pain), manual muscle testing for both upper and lower extremities were 4/5 except left knee flexion/extension 3+/5 due to pain, sensation on both UE/LE were intact to light touch, Stephen requires a moderate assistance of one person for both functional mobility and gait activity. He uses a front wheeled walker up to 35 feet due to decreased balance and antalgic gait from the left knee

DOI: 12/23/2013. The patient is a 64-year-old male foreman who sustained injury when he was involved in a motor vehicular accident. Per OMNI, he has had multiple injuries to the right shoulder, right knee, back and right arm/elbow. He is status post arthroscopic surgery for the right shoulder on 05/30/2014.

DOI: 12/28/2014. Patient is a 31-year-old male rebar installer who sustained injury while he was installing a rebar when he twisted his right knee. Per OMNI, he was initially diagnosed with right knee strain/sprain. MRI showed positive for a tear and he underwent surgery on 02/10/15 and subsequent MRI revealed teat versus scar tissue and he underwent right knee arthroscopic lateral meniscal debridement and synovectomy on 12/22/15.

Health History: A 25-year-old male injured his left knee in a recent skiing accident. The patient stated that he lost his balance because the inner edge of his right ski got caught while skiing. This resulted in the right leg being externally rotated followed by and audible “pop” as he lost footing. By evening, the right knee joint had become swollen, causing intense pain. The primary care physician referred the case to an orthopedist.

The patient underwent repeat MRI of his right knee on 1/28/16. As per office notes dated 7/25/16, review of system revealed that the patient has a history of weakness, shortness of breath, joint pain, muscular weakness, stiffness and muscular pain, headache and dizziness, as well as nervousness. The patient presents today stating that he would like to have his rod removed. He says that his right knee continues to give out on him and he wants to go on longer than 2 mile hikes without having knee pain and feeling instability. Examination of the right lower extremity revealed that the patient’s incisions are clean, dry, intact, and well-healed. The patient’s knee demonstrates discomfort with patellar grind-the symptoms are consistent with his last several exams, and are relatively unchanged. Knee is stable to varus and valgus stress, however, valgus stress does cause some discomfort on the lateral side. Distal neurovascular status is intact. Impression includes right displaced comminuted fracture of shaft of right femur, initial encounter for closed fracture; right chondromalacia patellae, right knee, and right sprain of other specified parts of right knee, initial

Introduction: In case of advanced knee arthritis, Total Knee Arthroplasty (TKA) represents an effective and reproducible surgical technique. In the last decade, Computer-Assisted Systems (CAS) have been introduced in TKA to allow more accurate prosthesis component implantation via intra-operative anatomy-based data tracking of the tibio-femoral joint (TFJ). Particularly, these systems were expected to result in better post-operative clinical outcomes under loading conditions and longer implant survivorship than Conventional Instrumentation (CI). This is generally due to more precise targeted bone cuts and Mechanical Axis (MA) using CAS. Unfortunately, only a few studies have compared so far TKA via CAS and CI at a long term follow-up in terms of clinical outcomes, MA alignment and implant survivorship.

DOI: 3/12/2013. Patient is a 57-year-old male service technician who sustained injury when he slipped and fell in mud while delivering a propane gas. Per OMNI, he is status post right knee surgery on 05/12/14.

Adequate control of postoperative pain following hip and knee arthroplasty can be a challenging task1,2. Previous studies have shown that over 50% of patients undergoing surgery report postoperative pain as a major concern3 .Inadequate control of pain may result in patient dissatisfaction, impaired patient rehabilitation, and prolonged hospitalizations3. The negative influence of postoperative pain on rehabilitation is particularly concerning for patients undergoing joint replacement. Functional recovery and return of muscle strength is dependent on the ability of these patients to comply with rehabilitation. The drawbacks of inadequate rehabilitation are especially cumbersome in hip and knee surgeries, since faster mobilization leads to quicker

S: TM works in GA, running 05R. He runs O5R, which requires turning and pushing with his left leg, then, 07L standing on his toes process. On 1/10/2017, he felt sharp, burning pain in his left outer lateral knee, while he was working with radiator hoses. When he turns on his left leg, on his left toes, he felt a sharp pain below outer lateral left knee. Since then there were several incidents, where he felt the burning or locking up sensations in his left outer lateral knee, when he turn his left foot to the right, on unleveled ground, and/or getting up from a sitting position. TM reports pain level is 5/10, when the symptoms occur and denies previous injury to the location. TM takes BC power PRN. TM wants

Andrea is a 41-year-old female. She weighs in at 150l pounds and is 5 feet 8 inches tall. The client had a knee surgery on the right knee back in February. She is cleared by the doctor for exercise. Her vitals were good heart rate at 72 and blood pressure 108/64. She did tell me here blood pressure does run on the low side and wasn't anything to worry about. During the overhead deep squat assessment, Andrea was leaning forward a little on her shoulders. This told me she had some issue in her thoracic spine area with some flexibility. She rated a 2 in this test. On the should mobility test her right shoulder measured a 4.5 inches and the left shoulder 5.5 inches. This would give her a 2 rating in this test due to the difference in shoulders.

The patient stated that he began experiencing painful swelling in his right knee over a decade ago. A large mass grew around the knee and he underwent a total knee arthroplasty. Not long after the arthroplasty of his right knee, he began experiencing similar symptoms in his left knee and right elbow.

DN is a 68 year old Caucasian male who lives in Pomona, Missouri. On September 14, 2009, DN underwent a scheduled left total knee arthroplasty at Baxter County Regional Medical Center. A consultation appointment about a total knee arthroplasty was scheduled when DN had increasing pain in his knees while doing chores and working on his dairy farm. The increasing pain DN was having been due to a history of osteoarthritis and the wear-and-tear on his joints throughout his life, no specific injury was noted. Depending on the outcome of the left knee, DN was consulted on having his right knee done in the future

My mother has knee pain for many years and recently it has worsened. She has some deformity around the knees and can barely walk more than 10-15 minutes. What should be done?

Introduction: A total knee replacement is a proven cost-effective treatment for end-stage osteoarthritis, with a positive effect on pain and function. However, only 80% of the patients are satisfied after surgery. The main reason to proceed with a TKA are pain and problems with activities of daily living (ADL). It is known that high preoperative expectations and residual postoperative pain are important determinants of satisfaction, but also malalignment, poor function and disturbed kinematics can be a cause.