Long Case 1 Osteoarthritis of Knee
Long
Case 1
Osteoarthritis
of Knee
Introduction
Exposure
General Examination
Apparently
Healthing looking ,
Conscious
Well
oriented to time place and person
Co-operative
Not in
distrees due to pain
………
Moderately
built up
Jaundice
Pallor Lymph Node Cyanosis Clubbing
Oedema Dyspnoea
Vitals
BP P T RR
Skin
Hair Distribution HEENT
Systemic
Examination
Chest
CVS
P/A
Musculoskeletal Examination
Upper Extremity
Spine – C – spine and L-spine
Head at centre
Shoulder and Pelvis Leveled
Normal overlying skin without any
dimpling/swelling on the back
Normal Movement of C-spine ,
Ask
patient to stand up
Thoracic and lumbar spine movements
tested
Lower Extremity –
Gait
- Varus / Valgus thrust or walks
slowly on a plodding manner loading knees on lateral compartment
Squating – Painful , One side heel higher than the other
Alignment
Pelvis Leveled
Both patella facing forward ,
Genu
Valgum deformity on Right side
Upper Extremity overlying Greater
Trochanter
No
flexion contracture at knee
Archs at feet normal
Posterior
( Measure Genu Valgum once you
see this and continue downward ..)
Attitude not any partcular on
lower extremities
Sitting again
Local Examination of Knee
Look Skin
Swelling
Discharge
Feel Temperature
Tenderness
Osteophytes
Movements Flexion
/ Extension
Crepitations
Stability
Varus
/ Valgus
Anterior
Drawer,Posterior Drawer,Lachman’s ,End points
Mc
Murray’s
Distal Circulation
Distal Sensation
Examination – Hip / Ankle / Foot
Neurology –
Sensation / power / Tone / Reflexes
Discussion
Inverstigations
X-ray – Weight
Bearing AP / Lateral Film of Knee –
OA changes – Joint Space narrowing
Osteophytes
Subchondral
Cysts
Subchondral
Sclerosis
Malalignment – Varus/ Valgus
Optional Views
Sunrise view
PA view with 30 degrees knee flexion
– shows early OA changes .
Knee OA and Aging Differences
|
Aging
|
OA
|
Water
Content
|
decrease
|
Increase
|
Collagen
|
.
|
disorganized
|
Proteoglycan
|
decrease
|
decrease
|
Chondrocyte
size
|
increase
|
.
|
Chondrocyte
number
|
decrease
|
.
|
Modulus
of Elasticity
|
increase
|
decrease
|
Risk factors for OA
Modifiable
1)trauma
2)occupation
3)muscle weakness
4)obesity
5)metabolic
6)metabolic syndrome (dyslipidaemia)
Non-modifiable
1)Gender
2)Older Age
3PGenetics
4)Race
Pathoanatomy
Articular
Cartilage – Increase water content , Collagen disorganized ,
Synovium –
inflammatory changes
Bone – Lytic
Lesions , bone cysts, sclerotic edges
Examine main ligaments
Posterior Sag – See tangentially anterior knee ,
PCL Deficiency – Quadriceps Active test
If PCL injured , what else to examine ?
Dial
test at 30 and 90 degrees
Management Plan ?
After Patellectomy and PCL deficiecy ?
Posterior
Stabilized TKR
What do you examine a patient with ACL and MCL
injury ?
Medial
joint line
O’Donoghue’s
triad
Alternatives
Acupuncture
Glucosamine compounds
Needle Lavage
Lateral Wedge Insoles
Surgery
High tibial
Osteotomy
Unicompartmental
Osteoarthritis
Unicompartmental
Arthroplasty – Higher revision rates than TKR
TKR – Symtomatic
Arthritis
Failed Non operative measures
Cruciate retaining versus Sacrificing TKR – No
difference
Patellar Resurfacing – no difference in function ,
pain
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