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Orthopedic Surgery

Joint Replacement

Summary

  • 54-year-old Caucasian Female with multiple delivery jobs and bilateral osteoarthritis of her knee
  • Patient did not want an orthopedic referral
  • Specialist provided multiple treatment options and recommendations on current regimen

eConsult Transcript

PCP submission

54-year-old Caucasian Female, with b/l knee OA.

She is a Uber and Doordash lady, where she has to use her knee aka climbing stairs almost every day. I have been helping her with Cortisone (triamcinolone 60mg) injections on b/l knee with a time gap of 6 weeks in each knee. She has probably gotten 4 Injections on each knee so far and now she is here for Round 5 on the Left knee followed by the Right Knee next month.

 

MEDICATIONS: TRIAMCINOLONE ACETONIDE 40mg/mL

 

My question is, she is trying to avoid the Knee X-ray along with an orthopedic referral overall. What would be your recommendations? and How long can I continue with Steroid shots? Last, how often can we do Knee injections, is it 4 weeks or 6 or 8 weeks?

Specialist response

Hi, thank you for your question! Based upon the information given, the patient appears to have significant knee osteoarthritis requiring frequent cortisone injections. There are 3 options in treating osteoarthritis. 

1) Physical therapy, focusing on quadricep strengthening, and oral NSAIDs to reduce inflammation. 

2) Intra-articular injections, which come in two types: cortisone or hyaluronic acid (ie. synvisc). 3) Surgery – the final option is a total knee arthroplasty. Though helpful, cortisone injections should only be given 1-2 times per year because with increased frequency, this can cause damage to the underlying cartilage and structures. I would not recommend the patient having injections every 6 weeks. At most, the patient should have cortisone injections every 6 months. The next option would be to try viscosupplementation injections like synvisc or euflexxa. These may be a little stronger than cortisone and typically are a 3-4 injection series done weekly. Again, these should only be done 1-2 times per year. If she fails to improve significantly with these injections, then x-rays and an eval for a total knee replacement is the last option. I hope this helps guide your treatment. Thank you for your consult!

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