Orthopaedic Consultation Update Letter

Patient's Name: Arthur Pendelton Date of Birth: 14/05/1958 Unit Number: 482 910 3847 Date of Letter: 24/10/2023

This letter provides an update on the assessment and management plan for our mutual patient, Arthur Pendelton,

The patient presented today for review of progressive right knee pain and mechanical locking.

Action for GP

• Please prescribe naproxen 500 mg PO BD and omeprazole 20 mg PO OD for flare-ups.
• Check baseline renal function (U&Es) prior to commencing NSAID therapy.

Action for Patient

• Continue daily quadriceps strengthening exercises as directed by physiotherapy.
• Aim for 5 kg weight loss to offload the medial compartment.

Summary of Patient Presentation

• Chronic right medial knee pain, worsening over 6 months, now limiting walking distance to 400 metres.
• Intermittent night pain and morning stiffness lasting < 30 minutes.
• Occasional catching sensations, no true giving way.
• Currently taking paracetamol 1,000 mg PO QDS PRN and using topical ibuprofen 5 % gel TID.
• Previously completed a 6-week course of outpatient physiotherapy and received an intra-articular corticosteroid injection 4 months ago (provided 6 weeks of relief).

Examination and Investigations

• Weight-bearing AP and lateral radiographs of the right knee (24/10/2023) demonstrate Kellgren-Lawrence grade 3 osteoarthritis, predominantly affecting the medial compartment with significant joint space narrowing and marginal osteophytes.
• Antalgic gait, mild varus alignment of the right knee.
• Small effusion present; tender along the medial joint line.
• ROM 5° to 110° with crepitus throughout; stable to varus/valgus stress and Lachman test negative; distal neurovascular status intact.

Management Plan

• Discussed surgical vs non-surgical options; patient wishes to defer arthroplasty for now.
• Administered repeat intra-articular injection of triamcinolone acetonide (Kenalog®) 40 mg and bupivacaine 0.5 % 5 mL to the right knee today under aseptic technique.
• Advised to step up oral analgesia via GP as outlined above.

Follow-Up

• Review in the Orthopaedic Outpatient Clinic in 6 months with repeat weight-bearing radiographs.
• Patient to contact the clinic sooner to list for right total knee replacement (TKR) if symptoms become refractory to conservative measures.

Please contact me if you need any further information or would like to discuss the patient's care in greater detail.

Sincerely,

Mr David Vance, FRCS (Tr & Orth) Consultant Orthopaedic Surgeon