New Patient - Note [Orthopaedic Surgeon]

Summary: - 45 year old female presents with chronic right knee pain, worsened by activity. - Diagnosis: Osteoarthritis, right knee (medial compartment dominant). - Plan: Commence physiotherapy, trial NSAIDs, and consider corticosteroid injection if conservative measures fail. Follow-up in 6 weeks. HOPC: - Patient reports chronic right knee pain for approximately 18 months, insidious onset. Pain is described as a dull ache, 6/10 at worst, exacerbated by climbing stairs, prolonged standing, and squatting. Some morning stiffness lasting less than 30 minutes. No locking or giving way reported. - Specific musculoskeletal concerns: Right knee pain and stiffness. - Detailed history: Pain began gradually without a specific injury. It has progressively worsened over time, impacting daily activities and recreational walking. Alleviated temporarily by rest and over-the-counter paracetamol. Associated symptoms include occasional crepitus. - Previous treatments: Has tried paracetamol with minimal relief. No previous physiotherapy or orthopaedic surgeries for this complaint. - Patient goals: Hopes to reduce pain and improve mobility to resume her regular walking routine without discomfort. - Patient's Ideas, Concerns, and Expectations: Concerned about potential progression of arthritis and keen to explore non-surgical options first. Hopes to avoid surgery if possible. Past medical and surgical Hx: - Past medical history: Hypertension, well-controlled with medication. - Previous surgeries: Appendectomy (20 years ago). Medications: - Current medications: Lisinopril 10mg once daily. Allergies: - Allergies: Penicillin (hives). Social history: - Social history: Right-handed. Works as an accountant, largely sedentary. Enjoys walking and gardening in her spare time. Non-smoker, occasional alcohol use (1-2 units per week). Lives with her partner, good home support. Examination and Investigations: - Examination findings: Right knee: Mild valgus deformity. Palpable crepitus with flexion/extension. Tenderness over medial joint line. Full extension, flexion to 120 degrees with pain at end range. Mild effusion. Ligaments stable. Strength 5/5 throughout. Gait antalgic on the right. Left knee: Unremarkable. - Investigations: X-ray right knee (standing views) - September 2024 (i-Med): Moderate joint space narrowing in the medial compartment, osteophytes, and subchondral sclerosis. MRI right knee - October 2024 (PRC): Confirms medial compartment osteoarthritis with meniscal degeneration and mild bone marrow oedema. Discussion and Plan: - Management plan: Discussed the diagnosis of medial compartment osteoarthritis of the right knee and available treatment options, both conservative and surgical. Patient consented to a trial of conservative management. Non-surgical treatment options include regular physiotherapy focusing on strengthening quadriceps and hamstrings, improving range of motion, and activity modification. Prescribed Celecoxib 200mg daily as a trial of NSAIDs. Educated patient on potential side effects of NSAIDs and importance of taking with food. Patient advised to use ice packs for acute pain and continue with paracetamol as needed. If conservative measures prove insufficient after 4-6 weeks, a corticosteroid injection into the knee joint will be considered. Pre-operative care and surgical options (e.g., knee arthroplasty) were briefly discussed as future considerations if conservative treatment fails. Patient to follow up in 6 weeks or sooner if symptoms worsen significantly. Activity restrictions include avoiding high-impact activities for the next few weeks. Patient's concerns regarding surgical intervention were addressed.