TKR knee effusion

[Jonathan Fenton]

I have a 79 y.o. fit and active farmer who had a TKR 2/11 and about 6 months later after "square dancing somewhat vigorously" developed knee pain and swelling. Ortho said it was fine and x-ray fine. My PE was positive for effusion, saphenous neuropathy and nerve like pain response from minimal brushing across the lateral aspect of the patellar tendon at the joint line.
US exam large effusion med/lat/supra and even posterior (but no Baker's) with suprapatellar debris that might be polyethylene debris since it didn't look like synovitis or fat. Bone-prosthetic junction was normal B mode and power doppler. Peroneal nerve looked normal above to below.
Any suggestions for further evaluation and/or treatment?



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Jonathan

[CLAN...@aol.com]

Good case Jonathan. I would drain the effusion and send it for culture. Do a Bone Scan and rule out loosening.  If all is negative and the Orthopedist has nothing else to offfer ask him about doing an irrigation of the knee and add antibiotic to solution. It might be an allergic reaction. Other option is to ask our ozone experts if Ozone is appropriate and try our new NPT therapy. Other safest option is to send the patient to another Orthopedist for a second opinion.  Good luck. ED Magaziner

 

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