Case report: Bilateral total knee replacement in severe knee osteoarthritis
Introduction 40 years old malay gentleman with underlying gout and hyper tension presented with chief complaint of bilateral knee pain for 10 years duration. He was walking with limping gait and unable to squat or sit cross legs. Pain had been increasing for the last 5 years. He was dependent...
| Main Authors: | , , |
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| Format: | Conference or Workshop Item |
| Language: | English English |
| Published: |
2016
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| Subjects: | |
| Online Access: | http://irep.iium.edu.my/62576/ http://irep.iium.edu.my/62576/6/62576%20BILATERAL%20TOTAL%20KNEE%20REPLACEMENT%20IN%20SEVERE.pdf http://irep.iium.edu.my/62576/1/poster%20harris%202%20copy%20small.jpg |
| Summary: | Introduction
40 years old malay gentleman with underlying
gout and hyper tension presented with chief
complaint of bilateral knee pain for 10 years
duration. He was walking with limping gait
and unable to squat or sit cross legs. Pain had
been increasing for the last 5 years. He was
dependent on analgesia. Since pain was
worsening patient was on wheelchair
ambulation. On examination patient right
knee, no swelling, fixed flexion at 10 degree,
range of movement 10-100 degree flexion,
lateral collateral laxity and varus deformity.
Left knee had fixed flexion at 5 degree, range
of movement 5-100 degree and varus
deformity. Blood investigation showed uric
acid. Xray of bilateral knee showed reduced
joint space, and sclerotic bone.
Methods
Patient underwent bilateral total knee
replacement. Left total knee replacement was
done followed with right total knee
replacement after 5 months. Intraoperatively
left knee noted intraarticular loose bodies and
uncontained posteromedial defect which was
build up with bone (screw fixation) and bone
grafting. Intraoperatively right knee noted
posteromedial defect over tibial articular
surface, incomplete iatrogenic fracture over
medial tibial plateau, augmented with 5mm
metal block over medial tibial plateau, bone
quality was good, sclerotic bone over medial
tibia plateau and multiple holes was drill over
the sclerotic bone.
Discussions
Post operatively wound was clean. Patient was
discharge well with oral antibiotic. He was
advised for non-weight bearing for 3 months.
He was referred to physiotherapy for range of
motion exercises. 1 year post operatively
patient able to ambulate with walking stick.
Pain score improved. Functional and knee
score is good. Range of movement bilateral
knee are 0-100 degree.
Conclusion
Outcome shows that total knee replacement is
a reproducible surgery for which a trained
surgeon will be able to produce excellent and
good results. |
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