The patient is a very pleasant 84-year-old white male who presents today with five to six years’ history of right medial knee pain. Approximately five to six years ago, he underwent a left knee replacement This knee has functioned very well. He had right knee pain complaints approximately the same time and opted to undergo viscosupplementation injections without imaging guidance. He stated that the shots had no effect on his overall pain. He did recently undergo x-rays at the Advanced Orthopedic Practice but does not have them for perusal today. He presents today for evaluation and consideration of image-guided viscosupplementation injections into the right knee.
He has right medial knee pain with ambulation and typically walks with a cane. He has a significant concordancy of pain ascending and descending stairs. He is barely ambulatory today due to the discomfort.
This is a self-referred 84-year-old gentleman with a five to six years history of right medial knee pain, which has not responded to non-image guided viscosupplementation injections approximately five years ago. The patient had been prepared to undergo right total knee replacement but did cancel it recently.
Right medial knee pain; most consistent with degenerative osteoarthropathy.
I had a very nice visit with the patient today. We discussed this case in detail. He wants to discuss image guided injections into the knee in order assure accurate placement for the viscosupplementation. I told him that in our practice, we would use either fluoroscopic guidance or ultrasound guidance in order to guarantee appropriate placement. I do not think any further workup needs to be done at this time, but I would like to see the films from the Orthopedics Practice and we will get in touch with their office to have those films as well as reports sent to our office prior to intervention.
I will start him on one to two weeks of physical therapy in order to gain accurate assessment of the knee while we authorize the viscosupplementation injection. My recommendation would be for injection of Hyalgan plus 20 mg Kenalog plus a combination of bupivacaine and lidocaine simultaneously. If we do well from one injection, I see no reason to continue forward with the series of injections, but if we are making slight improvements, we can move forward with series of three to five depending on patient’s response.
The patient seemed very happy with this visit today and I look forward working with him. He understands that due to my continuing to work half time on the West Coast and half time back here he may see one of the other physicians or physician’s assistants for the image-guided injection. He was fine with that. I will see him back at his follow-up or sooner if needed.