Physician 1st Quarter 2016 Joint Surgery IRR - Case Study #5
85-year-old with prior authorization request for right total knee arthroplasty (CPT 27447).
The patient has history of right knee pain for several years which has exacerbated recently. He underwent an arthroscopy eight months ago and got very little relief from that. He was found to have significant degenerative change intraoperatively, consistent with full thickness cartilage loss.
He has also failed additional conservative treatment, including corticosteroid injections and viscosupplementation injections over the last six months and presently uses a cane as an ambulatory aid.
His physical examination suggest a 10° flexion contracture and limitation in flexion to 105° with good stability and medial joint line tenderness.
Standing x-rays show advanced degenerative osteoarthritis about the medial and patellofemoral apartments with subarticular cyst formation, sclerosis and obliteration of the medial joint line.
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