Case PresentationCase Presentation

Son Eui Young 2007313075Son Eui Young 2007313075

Sungkyunkwan UniversitySungkyunkwan University

School of MedicineSchool of Medicine

Chief ComplaintChief Complaint

67/F, Both knee pain67/F, Both knee pain– Onset : 20YAOnset : 20YA

Present IllnessPresent Illness

2020 년전부터 시작된 양슬관절 통증 년전부터 시작된 양슬관절 통증 (Left > Right)(Left > Right)

최근 최근 22 년동안 악화됨년동안 악화됨

평지나 계단 오를 때평지나 계단 오를 때 , , 쪼그려 앉거나 일어날 때 쪼그려 앉거나 일어날 때 통증 호소통증 호소 , , 계단 내려가는 것은 아파서 못한다계단 내려가는 것은 아파서 못한다 ..

Trauma history : Trauma history : 없음없음

Present IllnessPresent Illness

보존적 치료에도 호전 없어 인공관절 수술 결정보존적 치료에도 호전 없어 인공관절 수술 결정

2012. 02.15 – 2012. 02.15 – 수술적 치료 위해 입원수술적 치료 위해 입원

Past Medical HistoryPast Medical History

고혈압 고혈압 (No)(No) 당뇨병 당뇨병 (No)(No)

결핵 결핵 (No)(No) 간염 간염 (No)(No)

알레르기 알레르기 (No)(No) 항생제 알레르기 항생제 알레르기 (No)(No)

Review of SystemReview of System

General activity : DecreasedGeneral activity : Decreased Oral intake : NPO stateOral intake : NPO state Fever/chill (-/-)Fever/chill (-/-)

Sore throat/rhinorrhea/sneezing (-/-/-)Sore throat/rhinorrhea/sneezing (-/-/-) Cough/sputum/hemotpysis (-/-/-)Cough/sputum/hemotpysis (-/-/-) Dyspnea/orthopnea (-/-)Dyspnea/orthopnea (-/-)

Nausea/vomiting (-/-)Nausea/vomiting (-/-) Constipation/diarrhea (-/-)Constipation/diarrhea (-/-) Hematemesis/melena/hematochezia (-/-/-) Hematemesis/melena/hematochezia (-/-/-)

Physical ExaminationPhysical Examination

Vital sign (2012-02-15 14:54)Vital sign (2012-02-15 14:54)– BPBP 135/81 mmHg135/81 mmHg RRRR 86.086.0 /min/min– RRRR 1818 /min/min BTBT 35.635.6 ℃℃

Knee ROMKnee ROM– FCFC 5/55/5 FFFF 150/150150/150– VarusVarus 5/105/10 PCTPCT +++/++++++/+++– Crepitus Crepitus +/+++/++

Knee X-rayKnee X-ray

Knee X-rayKnee X-ray

Problem ListProblem List

1.1. Both knee painBoth knee pain

2.2. Crepitus (+)Crepitus (+)

3.3. Asymmetric knee joint narrowingAsymmetric knee joint narrowing

AssessmentAssessment

Advanced Osteoarthritis knee, bilateralAdvanced Osteoarthritis knee, bilateral

Rheumatis arthritisRheumatis arthritis Knee FractureKnee Fracture

OperationOperation

2012-02-16 : Left TKA2012-02-16 : Left TKA

2012-02-22 : Right TKA2012-02-22 : Right TKA

Post-op. X-rayPost-op. X-ray

Progressive NoteProgressive Note

2012-02-26 (POD 3)2012-02-26 (POD 3)– Vital sign stableVital sign stable– Pain tolerablePain tolerable– Wound clearWound clear– No immediate complicationNo immediate complication

OA OA 방사선 소견방사선 소견

Severity of OASeverity of OA

K-L classificationK-L classification

Grade 1: doubtful narrowing of joint Grade 1: doubtful narrowing of joint space and possible osteophytesspace and possible osteophytes

Grade 2: definite osteophytes, definite Grade 2: definite osteophytes, definite narrowing of joint spacenarrowing of joint space

Grade 3: moderate multiple Grade 3: moderate multiple osteophytes, definite narrowing of joints osteophytes, definite narrowing of joints space, some sclerosis and possible space, some sclerosis and possible deformity of bone contourdeformity of bone contour

K-L classificationK-L classification

Grade 4: large osteophytes, marked Grade 4: large osteophytes, marked narrowing of joint space, severe narrowing of joint space, severe sclerosis and definite deformity of bone sclerosis and definite deformity of bone contourcontour

OA – TreatmentOA – Treatment

EducationEducation– Posture, habit, occupationPosture, habit, occupation– 지팡이 등의 보조기구지팡이 등의 보조기구– 체중 감량체중 감량

MedicationMedication– Oral : NSAIDS, COX-2 inhibitor, Tramadol, Oral : NSAIDS, COX-2 inhibitor, Tramadol,

HydrochlorideHydrochloride– Injection : Hyaluronan, GlucocorticoidInjection : Hyaluronan, Glucocorticoid

OA – TreatmentOA – Treatment

SurgerySurgery– OsteotomyOsteotomy– Arthroplasty, ArthrodesisArthroplasty, Arthrodesis

Simultaneous bilateral TKASimultaneous bilateral TKA

비용은 비용은 58% 58% 정도 저렴 정도 저렴 (by campbell’s)(by campbell’s) 추가 입원 일 수 증가 추가 입원 일 수 증가 (Bi 89%, Uni 45%)(Bi 89%, Uni 45%) Postop. Thrombocytopenia Postop. Thrombocytopenia 증가증가 Blood loss Blood loss 량 증가량 증가 DVT, PE DVT, PE 발생율 증가발생율 증가 8080 세 이상에서는 세 이상에서는 cadiovascular cadiovascular 와 와 neurological neurological

complication complication 증가증가

Comorbidity Comorbidity 와 와 physiological agephysiological age 가 고려되어야 함가 고려되어야 함

ReferencesReferences

CAMPBELL’s Operative Orthopaedics CAMPBELL’s Operative Orthopaedics 1111thth Ed. Ed.