Diagnosis:
- Right knee osteoarthritis
Plan:
- Physiotherapy referral for quadriceps strengthening and pain management.
- Prescription for Celecoxib 200mg daily as needed for pain.
- Review in 3 months with follow-up X-rays of the right knee.
Thank you for referring Mr. Arthur Pendelton who I reviewed today. Arthur is a 68 year old retired carpenter male who presents with chronic right knee pain.
Mr. Pendelton reports a gradual onset of right knee pain approximately 18 months ago, with no specific injury. The pain is described as a deep ache, rated 6/10 on a visual analogue scale, worse with weight-bearing activities, prolonged standing, and climbing stairs. He finds relief with rest and occasional paracetamol. He denies any locking, clicking, or instability. Previous treatments included over-the-counter pain relievers and a brief course of physiotherapy which provided minimal relief. He explicitly denied considering a knee brace.
Mr. Pendelton lives at home with his wife and is generally active, enjoying gardening and short walks. He has a history of controlled hypertension, managed with Amlodipine 5mg daily, and hypercholesterolaemia, managed with Atorvastatin 20mg daily. He underwent an appendectomy in 1985. He has no known allergies. He occasionally drinks alcohol and is a non-smoker.
On examination, there was a mild effusion of the right knee with palpable crepitus during flexion and extension. Range of motion was 0-110 degrees flexion, with pain at the extremes. Ligamentous stability was intact. Quadriceps strength was 4/5 bilaterally. X-rays of the right knee performed on October 2024 at i-Med demonstrated significant joint space narrowing, osteophyte formation, and subchondral sclerosis consistent with advanced osteoarthritis.
We discussed the diagnosis of right knee osteoarthritis, explaining the degenerative nature of the condition. Non-operative management options, including physiotherapy, weight management, and analgesia, were reviewed. Surgical options, specifically total knee arthroplasty, were also discussed, including potential risks such as infection, bleeding, and the need for rehabilitation. Mr. Pendelton was provided with information leaflets on knee osteoarthritis and total knee replacement surgery. He expressed concerns about the recovery period following surgery but was receptive to exploring conservative measures first.
Thank you for your ongoing care of Arthur. Please feel free to get in touch if you have any questions or require further information regarding the management plan.
