Knee Replacement Case Study

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

12/24/15 Progress Report describes that the patient has right knee pain. The pain is frequent. It is aching and burning in quality. The current pain level is 0/10 and worst pain is 4/10. Bending, squatting, walking, weight bearing, changing clothes and ROM aggravate the pain. Rest, ice,

Dr. Justin Clayton at the Mercy Clinic Orthopedic Surgery evaluated the claimant on April 6, 2018. Dr. Clayton stated the claimant may have rheumatoid disease and prescribe him Meloxicam. In addition, he reported the claimant would be referred for further arthritis evaluation (Ex. 23F).

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

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

On physical examination of the right knee, the patient is tender at the joint line and lateral meniscus.

Poor fluidity and quality of motion was also noted. Muscle strength testing shows 4/5 with right psoas major and iIliacus group, right quadricep and hamstring muscle group, right gastrocnemius and tibialis anterior, and right extensor digitorum longus. Kemp’s test, Valsalva Maneuver, Bragard’s Sign, Lasegue (Straight Leg Raise) test and Yeoman’s test are positive bilaterally. Milgram’s test is also positive.

PHYSICAL EXAM: He is in discomfort. He cannot straighten his knee out completely. He has a large bulky dressing on his knee and a brace.

Per the AME report dated 07/08/15, the patient was deemed P & S with regard to her right knee and lumbar spine as of this date. Future medical care includes ongoing exercise program, occasional orthopedic visits, brief periods of PT, anti-inflammatory medications for flares, prescription medications and periodic injections.

Based on the latest medical report by Dr. Sudberg dated 12/09/15, the patient complains of worsening right knee pain with clicking, right leg numbness and improving left hip pain. Pain is rated as 7/10.

The patient has difficulties ambulating stairs. Her pain is waking her up at night. She failed to improve with the plethora of conservative treatment entailing physical and acupuncture therapies, activity modifications, home-type exercise, injections, medications. On physical examination, the patient is utterly uncomfortable. She ambulates with antalgic gait. Well healed incisions are noted on the left knee. Patellar crepitus noted on the flexion and extension of the right knee with medial and lateral joint line tenderness more so in the medial side. McMurray's test is positive medially. Patellar crepitus is noted together with pain in patellar compression. Patient’s Voltaren gel was refilled. Patient was recommended to undergo right knee arthroscopy with partial meniscectomy and lateral patellar release surgery. She failed to improve with above mentioned conservative treatment. Any further conservative treatment will be of no benefit. Patient was also recommended 12 PT sessions for the right knee

Based on the latest medical report dated 03/24/16, the patient presents for follow-up of his right knee pain. He ambulates with a cane. He has completed a series of Hyalgan injections in 09/2015 in the right knee which lasted for 1 month. He would like to begin a new series of Hyalgan injections.

Based on the latest medical report dated 03/08/16 by Dr. Tenuta, the patient presents for his right knee pain. He was seen for back pain approximately a year ago. He has had persistent issues with that. He feels that he has been favoring his knees. He has been having problems going up and down steps. On examination, he has crepitus with patellofemoral range of motion. As of this

| Admission Diagnosis: Left Total Knee Arthroplasty &Excision of Left Knee Mass Related to Gouty Arthritis

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