Ace the Case: A 60-Year-Old-Man With Worsening Chronic Right Knee Pain

Issue: August 2018

A 60-year-old man presents with worsening chronic right knee pain.

The patient has attempted NSAIDs and physical therapy with minimal relief in the past. He used to be an avid cyclist, but his worsening knee pain now limits his ability to stay active. He can only walk up to one-half mile at a time, with a limp, and he must hold onto a railing when going up and down stairs. He works as a hospital management consultant, requiring frequent long-distance travel. He is to leave for a speaking tour in 1 week.

On physical examination, he is otherwise healthy with a BMI of 27 kg/m². He has an obvious varus deformity of his right knee with a palpable, moderate effusion, and he walks with an antalgic gait. He understands that he will ultimately likely need to have a total knee arthroplasty to maintain his lifestyle, but wants to delay this as long as possible.

X-ray shows a varus knee with nearly complete loss of the medial joint space with associated subchondral sclerosis.

Optimal treatment at this time includes:

A. Corticosteroid injection

B. Platelet-rich plasma injection

C. Stem cell therapy

D. Hyaluronic acid injection

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Learning Objectives:

Upon successful completion of this educational activity, participants will be better able to assess the diagnosis and treatment of knee pain.

Overview

Author(s)/Faculty: Naudereh Noori, MD; Andrew Spitzer, MD
Source: Healio Rheumatology Education Lab
Type: Monograph
Articles/Items: 4
Release Date: 6/15/2018
Expiration Date: 6/14/2019
Credit Type: CME/ABIM MOC
Number of Credits: 0.25
Cost: Free
Providers: Vindico Medical Education

CME Information

Provider Statement: This continuing medical education activity is provided by Vindico Medical Education.
Support Statement: There is no commercial support for this activity.
Target Audience: The intended audience for this activity is rheumatologists and other health care professionals.