ortho case presentation a different case scenario

Valgus knee

1. Complex Varus Knee Dr. Antara Dr. Rudra Narayan Dash

2. Case : 01 Clinical Presentation 75 years old female patient admitted with complain of pain in both knees for last 10 years and deformity in both knees for last 5 years History of present illness: Patient has pain in both knees for last 10 years which was insidious in onset, gradually progressive, initially controlled by medication Since last 1 year the pain was not relieved with medications Then she developed bowing of both legs which was progressive.

3. Past history Diabetes Mellitus, Hypertension and Hyperlipidemia Treatment history Pain Medications and physiotherapy Knee brace

4. Lower Limb Examination Inspection B/L knee varus deformity with lateral tibial subluxation and FFD Palpation Joint line tenderness- medial and lateral ROM Crepitus present Right knee- 10 degrees FFD, further flexion up to 80 degrees Left knee- 20 degrees FFD, further flexion up to 80 degrees Varus deformity- B/L varus deformity Gait- Varus Thrust Gait

5. Preoperative clinical images

6. Preoperative radiographs

7. Preoperative radiographs Scanogram

8. Planned for Total Knee Replacement (Stagged) Investigations sent CBC, RFT, Serology, Urine culture, Throat swab Xray Chest PA view, ECG, Xray B/L knee AP, Lateral views, Scanogram PAC- Fit for surgery

9. Right knee was operated in May 2024 Left knee was operated in June 2024 After the left knee TKR patient was mobilized on post op day 2 with bilateral knee brace

10. Case : 02 Clinical Presentation 72 years old female admitted with complain of pain in both knees for last 8 years and deformity in both knees for last 5 years History of present illness: Pain in both knees for last 08 years which was insidious in onset, gradually progressive. She developed bowing of both legs. The deformity is progressive Patient was diagnosed with rheumatoid arthritis and started on DMARDs, but stopped medications after some time.

11. Past history Diabetes Mellitus, Hypertension and Rheumatoid Arthritis Treatment history Pain Medications and physiotherapy DMARDs

12. Lower Limb Examination Inspection B/L knee varus deformity with lateral tibial subluxation and FFD Palpation Joint line tenderness- medial and lateral ROM Right knee- 10 degrees FFD, further flexion up to 70 degrees Left knee- 20 degrees FFD, further flexion up to 80 degrees Varus deformity- B/L varus deformity Gait- Waddling gait

13. Preoperative clinical images

14. Preoperative radiographs

15. Preoperative Scanogram

16. Planned for TKR (Stagged) Investigations sent CBC, RFT, Serology, Urine culture, Throat swab Xrays Chest PA view, ECG, Xray B/L knee AP, Lateral views, Scanogram PAC- Fit for surgery DMARDs stopped 2 weeks before surgery

17. Right knee was operated in June 2024 Left knee was operated in July 2024 After the left knee TKR patient was mobilized on post op day 2 with bilateral knee brace

18. Complex Valgus Knee Dr. Nitesh Singh Dr. Chiranjib Mishra

19. Case :03 A 66 years old lady presented with chief complain of pain at right knee for last 6 years Deformity at right knee joint for 4 years And while walking her both knees were rubbing with each other and causing discomfort

20. History Of Present Illness She was having pain in right knees for 6 years, which was progressive in nature localized to knee, non radiating pattern and aggravated with movement and partially relieved by oral medication. Pain has severely increased in last 6 month and not relieving even after higher doses of medication. She has difficulty in squatting, sitting down and climbing stairs for last 2 years Deformity has increased for last 6 months and it is causing difficulty while walking.

21. Past history Patient having no significant past history related to that condition She is hypertensive and on anti hypertensive medications Treatment history Analgesics Physiotherapy Knee brace

22. Local examination Inspection Valgus deformity at right knee joint approx. 25 degree Sagittal plane deformity- fixed flexion deformity at around 10 degree was present Palpation Joint line tenderness- Medial Deformity was non correctable on varus stress ROM was 10 to 100 degree of flexion Distal neuro vascular status is intact

23. Preoperative clinical images

24. Preoperative clinical images

25. Preoperative radiographs

26. Preoperative Scanogram Femoro -tibial angle Right : 18 degrees valgus

27. Planned for Right TKR Investigations sent Cbc , Rft , Serology , Urine Culture ,Throat Swab, Blood Culture Xrays , ECG, 2D ECHO PAC- Fit for surgery

28. Right knee was operated in Aug 2025 After the right knee TKR patient was mobilized on post op day 2 with knee brace

29. Case : 04 55 years old lady presented with Chief complain of Pain at both knee joint for last 15 years Deformity over both knee joint which is progressive in nature

30. History Of Present Illness She was having pain in both knees for 15 years, which was progressive in nature localized to knee non radiating pattern and aggravated with movement and partially relieved by oral medication. Pain has severely increased in last 6 month and not relieving even after higher doses of medication. She has difficulty in sitting down and climbing stairs Deformity has increased for last 6 months and it is causing difficulty while walking.

31. Local examination Inspection Valgus deformity in both knees, left more than right Palpation Joint line tenderness Deformity was rigid non correctable on varus thrust MCL was stretched but intact with no attenuation clinically

32. ROM- Right knee- 0 to 100 degree Left knee- 0 to 110 degree Valgus deformity- Right knee- 20 deg Left knee- 24 deg

33. Preoperative clinical images

34. Preoperative radiographs

35. Preoperative Scanogram Femoro -tibial angle Right : 20 degrees Left : 24 degrees

36. Planned for TKR (Stagged) Investigations sent CBC, RFT, Serology, Urine culture, Xray Chest PA view, ECG, Echocardiogram Xray B/L knee AP and lateral views, skyline views, Scanogram PAC- Fit for surgery

37. Left knee was operated in May 2025 Right knee was operated in Aug 2025 After the left knee TKR patient was mobilized on post op day 2 with knee brace