ICJR CASES: How Would You Manage These 10 Challenging TKA Patients?

    A 55-year-old male patient presents with bilateral degenerative joint disease. He’s otherwise healthy, with a BMI of 25 and no medical comorbidities. Do you offer simultaneous bilateral total knee arthroplasty (TKA), or do you recommend staged procedures?

    A 35-year-old, wheelchair-dependent female patient presents with right knee pain. She’s undergone 3 knee arthroscopies and is now on oxycodone, 80 mg twice a day, for the pain. How will her opioid use factor into your surgical plan?

    A 68-year-old male patient with right knee pain has hardware in that leg from a distal femur fracture 30 years prior. He has failed conservative therapy and wants a TKA to relieve the pain that is substantially limiting his activities. How will you deal with the existing hardware?

    These complicated primary TKAs were among the cases moderator Matthew S. Austin, MD, presented to a panel of experienced surgeons at ICJR’s 11th Annual Winter Hip & Knee Course, asking them to review the physical exam and radiographic findings and then – on the spot – to comment on how they would manage the patients.

    RELATED: Register for ICJR’s 12th Annual Winter Hip & Knee Course

    Panel members included:

    • Matthew P. Abdel, MD, Mayo Clinic, Rochester, Minnesota
    • James A. Browne, MD, University of Virginia, Charlottesville
    • H. Del Schutte, MD, Charleston Institute for Advanced Orthopedics, Mount Pleasant, South Carolina
    • Scott M. Sporer, MD, MS, Rush University Medical Center, Chicago, Illinois
    • Michael J. Taunton, MD, Mayo Clinic, Rochester, Minnesota
    • Jonathan M. Vigdorchik, MD, Hospital for Special Surgery, New York, New York

    Below is a sampling of the other cases Dr. Austin shared with the panel. To hear more, click the image above.

    60-year-old Female with Left Knee Pain

    • History of septic arthritis in the knee; occurred 6 months prior following a corticosteroid injection
    • Methicillin-sensitive Staphylococcus aureus (MSSA) infection treated with arthroscopic irrigation and debridement twice, following by intravenous antibiotic for 6 weeks
    • No pain relief from viscosupplementation 3 months prior to presentation
    • Range of motion (ROM) of the affected knee: 0° to 120°
    • Varus alignment

    54-year-old Male with Left Knee Pain

    • Pain of 4 to 6 weeks’ duration
    • No improvement after corticosteroid injection
    • ROM of affected knee: 20° to 110°
    • Valgus alignment
    • Hip ROM painless

    26-Year-Old Male with Right Knee Pain

    • Complicated surgical history of the affected knee: Surgery for patellar instability in February 2011, irrigation and debridement for MSSA infection in March 2011, manipulation under anesthesia in April 2011
    • Pain limiting activities of daily living and walking tolerance; manual laborer at an oil refinery
    • ROM of affected knee: 20 to 95
    • Significant antalgic gait
    • No overt signs of infection in the knee

    Click the image above to watch the presentation and hear all 10 cases presented by Dr. Austin.