Orthopaedic Consultation Note

Diagnosis/ Presenting Complaint

R knee OA. PC: 18/12 hx of progressive, atraumatic medial joint line pain and morning stiffness (< 30 mins). Exacerbated by weight-bearing and stairs. Disturbs sleep. Failed conservative management (physio and analgesia).

Outcome

Listed for elective R total knee replacement (TKR). Referred to pre-operative assessment clinic.

Age

64 years

Occupation

Self-employed plumber. Job requires frequent kneeling, heavy lifting, and prolonged standing; currently unable to work full-time due to knee pain.

Past Medical History

• HTN
• T2DM
• BMI 31 kg/m²
• R knee arthroscopic partial medial meniscectomy (12 years ago)
• Regular meds: amlodipine 5 mg PO OD, metformin 500 mg PO BD, paracetamol 1,000 mg PO QDS PRN, naproxen 500 mg PO BD PRN.

Discussion/ Outcome

Weight-bearing AP/lateral XR R knee reviewed: severe tricompartmental OA, worst in medial compartment with bone-on-bone contact, subchondral sclerosis, and osteophytes. O/E: antalgic gait, mild varus alignment, small effusion, ROM 10°–95° (flexion contracture), crepitus +, stable to varus/valgus stress, distal NVI.

Discussed non-operative vs operative management. Given exhaustion of conservative measures and significant impact on livelihood, pt keen for surgery. Counselled on R TKR:

• Expected benefits: pain relief, improved function/mobility.
• Risks discussed: infection, bleeding, DVT/PE, neurovascular injury, stiffness, prosthetic loosening/wear, persistent pain, and medical complications.

Pt understands and wishes to proceed. Consent form signed. Referred for pre-op assessment, baseline bloods, and anaesthetic review. Advised to stop naproxen 7 days pre-op. Follow-up on day of surgery.