A 74-Year-Old Woman

and Iain McNamara1

Trauma & Orthopaedics, Norfolk & Norwich University Hospital, Norwich, United Kingdom


A 74-year-old woman was seen in a general orthopaedic clinic having been referred by her GP in response to an X-ray report. She had complained of pain in her knees. She was known to have cervical spondylosis, for which she had had facet joint injections and was taking strong painkillers. The X-rays had been reported as showing severe patellofemoral arthritis. It was noted that she was obese (BMI 33) and that she had correctable hindfoot valgus helped by orthotics. Her hip examination was normal and her knee alignment was straight. After being seen by the orthopaedic surgeon, it was felt that she was not suitable for a knee replacement, but a second opinion was requested.

When seen in the Patella Clinic, it was noted that she had a degenerative polyarthropathy. Although she experienced pain at the front of her knees, she had more problems with pain in her feet, neck, and lumbar spine.

Question 1

What is your likely management plan and why?

Past Medical History

Varicose vein surgery.

Current Medication

Acyclovir, oestradiol, paracetamol, amitriptyline, buprenorphine patches, and gabapentin


She was obese. Her overall limb alignment was straight with a normal rotational profile. The correctable hindfoot valgus was confirmed. There was no effusion in either knee. She had reduced VMO bulk (MRC power 4+). Her range of knee motion 0°/0°/120° bilaterally. Her hip examination was normal. She was tender over her cervical spine and mid-lumbar spine. She had no distal neurovascular deficits.

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Sep 26, 2017 | Posted by in ORTHOPEDIC | Comments Off on A 74-Year-Old Woman

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