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A Fifty-three-Year-Old Woman with Osteoarthritis of the Knees1
Aasis Unnanuntana, MD, Rathachai Kaewlai, MD, and Richard E. Grant, MD*
Department of Orthopaedics, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio (A.U. and R.E.G.), and Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (R.K.). E-mail address for A. Unnanuntana: uaasis@yahoo.com
A fifty-three-year-old woman with a history of colitis, hypertension, and bipolar disorder presented to our hospital with a two-year history of bilateral knee pain. The pain was localized to both knees, was greater in the right knee than in the left, and did not radiate to the calves. Activities such as climbing up and down stairs aggravated the pain, whereas rest relieved it. She had no history of recent injury or previous fractures. Radiographs showed evidence of tricompartmental degenerative arthritis of both knees (Figs. 1-A and 1-B). Nonoperative treatment with anti-inflammatory medications did not relieve the symptoms, which progressed to the point at which daily activities were severely limited. The patient agreed to undergo right total knee arthroplasty and received medical clearance from her primary care physician. The preoperative hip and spine examination revealed normal findings. The serum levels of alkaline phosphatase, calcium, phosphate, and parathyroid hormone were within normal limits. Standard preoperative radiography of the chest was performed (Fig. 2).
Fig. 1-A |
Fig. 1-B |
For larger view, click on image
Fig. 2 |
The patient underwent total knee arthroplasty of the right knee with use of a fixed-bearing posterior cruciate-substituting cemented total knee implant. During the procedure, the femoral canal could not be broached; the subchondral bone was dense and sclerotic. Because of the density of the bones, an extramedullary alignment guide was used instead of intramedullary femoral alignment rods. Bone cuts were unusually difficult because of the presence of sclerotic bone.
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