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

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).

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.

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

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

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.

MRI of the right knee without contrast dated 10/1/14 revealed lateral patellar tilt and subluxation with mild chondromalacia of the patella. There is small joint effusion. Baker cyst is noted. There is horizontal tear of the

IMAGING: X-ray reveals a tibial eminence displaced fracture. He is skeletally immature, as his age indicates.

As stated earlier, the patient admitting challenge was right total knee replacement related to history of osteoarthritis as evidenced by unrelieved pain. Osteoarthritis (OA) is a disease that “results from cartilage damage that triggers a metabolic response at the level of the chondrocytes” (Lewis, Dirksen, Heitkemper, Barry, Goldsworthy & Goodridge, 2011, p. 1881). As it progress, it causes the cartilage to become “dull, yellow, and granular” instead of being “smooth, white, translucent” (Lewis et al., 2011; Gulanick & Myers, 2014, p. 1881).As a result, it eventually becomes softer, less elastic, and less capable to resist wear during heavy use. Moreover, as the “central cartilage becomes thinner, cartilage and bony growth increases at the joint margins … that results to uneven distribution of stress across the joint” that contributes to a decrease in motion. (Lewis et al., 2011; Gulanick & Myers, 2014, p. 1882). According to this patient, OA has been giving her pain for about two years that lead her to the decision of having the knee replacement.

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

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

A patient is complaining of pain in the front part of his right knee. The patient has been experiencing this pain for the past year following an accident where he “missed a step” going upstairs and fell. There is pain at the sense of touch on the patient`s middle lower thigh, the inner part of the knee cap, and the joint of the thigh. The patient experiences no pain above the knee. When the patient moves his knee it causes pain to occur.

Brief Description of Patient: Patient is a 45 year old male who was diagnosed with osteoarthritis of his left knee. The pain in his knee was limiting him from doing his job and his every day activities. The orthopedic surgeon had the patient do physical therapy to see if this would help. The therapy was not helping the patient so the surgeon decided to do a total knee replacement.

A: Acute pain on the right knee, especially upon turning and repositioning; Patient is at risk for