Knee problems

Contributed by Dr Philip Marazzi, a GP in East Horsley, Surrey

Baker's cyst

This man had a previous total knee replacement for osteoarthritis (OA), and developed this Baker's cyst, also known as a popliteal cyst. Baker's cysts seem to form as a result of synovial fluid from the knee being forced backwards forming a 'cyst' from the back of the joint.

No action has been taken so far, although the patient does get some pain and has been offered surgery as an option.

Osteoarthritis

This man had a long history of OA.

He twisted his knee causing it to swell rapidly. When he came to the surgery one day later, his knee was quite tight and very uncomfortable so the effusion was aspirated providing immediate relief of his symptoms.

Care must be taken when aspirating or injecting a joint not to introduce infection.

Patients should be advised to re-attend for review if there are signs of inflammation or infection following the procedure.

Osgood-Schlatter disease

This young man has classical Osgood-Schlatter disease with swelling and tenderness of the tibial tuberosity. He was a very sporty lad, and struggled with the idea of a relatively uncertain period of rest.

The condition is relatively rare over the age of 18, and usually resolves spontaneously. Sport may be continued, but pain may limit this activity.

Physiotherapy to help with quadriceps exercises may also be of some benefit. Immobilisation in plaster or surgery is reserved for severe and persistent cases.

Acute effusion

This young man also presented with an acute effusion of the knee following an URTI. There was no history of any trauma to the knee nor any family history of joint problems.

The original respiratory infection rapidly resolved, and there were no associated symptoms.

No action was taken other than general advice about support, ice packs and analgesia. It resolved spontaneously, with no sequelae.

Post-op infection

This man underwent meniscectomy and developed what appeared to be a wound infection two weeks later.

The knee joint itself was not infected or swollen, and it turned out he had an infected pre-patellar bursitis.

A course of oral antibiotics resolved it rapidly. The knee itself continued to settle down with no problems.

Reiter syndrome

This young man presented with a painful knee with no history of trauma. On questioning he also gave a history of urethral discharge, although he did not have any ocular symptoms.

He was referred to a GUM clinic for proper assessment and treatment. His knee settled with anti-inflammatories, and his urethritis with antibiotics.

There may be a genetic susceptibility to this condition, with an association with the HLA-B27 gene.

 

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