23. November 2009 16:46
A 62-year-old lady who is known to have severe OA of her right knee presents to you wanting referral to a knee surgeon for a knee replacement. She smokes 15 cigarettes a day and is obese, with a BMI of 32. She has tried changing her footwear and was referred last year to an exercise programme but she had to stop because the exercise made her pain worse. Subsequently she is unable to lose weight.
Despite being on regular paracetamol, ibuprofen and tramadol, the pain is slowly increasing week by week, to the point where she is having difficulty leaving the house, and has taken to sleeping downstairs in a reclining chair because she finds the stairs too painful to climb.
Which one of the following options is your best next step?
- Intra-articular corticosteroid injection
- Intra-articular hyaluronan injection
- Intra-articular traumeel injection
- Morphine sulphate sustained release 5 mg BD
- Referral for TKR
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