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Clinical Crossroads | Clinician's Corner

A 57-Year-Old Man With Osteoarthritis of the Knee

Jess H. Lonner, MD, Discussant
JAMA. 2003;289(8):1016-1025. doi:10.1001/jama.289.8.1016.
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DR SHIP: Mr V is a 57-year-old man who has had knee pain for at least 30 years. He lives in Boston with his wife, with whom he owns and runs a business. He has managed care insurance and sees his primary care physician, Dr P, at Beth Israel Deaconess Medical Center.

Mr V dates the onset of his left knee problems to a soccer injury at age 26. He was diagnosed with rupture of 2 ligaments and underwent a course of physical therapy. His pain diminished over time, but he was aware that his left knee was never again at "100%." He continued his active athletic life, which included soccer, bicycle racing, and running at least 3 times per week. About 15 years ago, however, pain in his left knee recurred and became severe enough that he stopped running and moved largely to long-distance cycling. Thirteen years ago he underwent an arthroscopic debridement. This improved his level of function and decreased his pain for approximately 2 years, but symptoms subsequently recurred. He has since had several courses of physical therapy but has found the recommended exercises to be so painful that he could not complete them.

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Figure 1. Radiographs of Knee Osteoarthritis
Graphic Jump Location
Radiographs taken of Mr V's knee. A, Anteroposterior view showing advanced tibiofemoral arthritis with osteophytes, subchondral erosive changes of the tibial plateau, and a large contained subchondral cyst in the tibia. B, Lateral view showing advanced patellofemoral arthritis as well as tibiofemoral osteophytes and the tibial cyst. C, Sunrise radiograph demonstrating patellofemoral arthritis. The patella is centrally seated within the trochlear groove.
Figure 2. Radiographs of Unicompartmental and Total Arthroplasties
Graphic Jump Location
A, Anteroposterior radiograph of a unicompartmental arthroplasty resurfacing an arthritic medial compartment. B, Anteroposterior radiograph of a total knee arthroplasty.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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