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        • Low Supracondylar Femoral Fracture 2nd case
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Secondary Care - Examination
Commissioning guide 2013 Painful osteoarthritis of the knee 


weight bearing X-rayDifference in the medial joint line height between weightbearing (right) and non-weightbearing (left) X-ray.
In secondary care patients will be assessed  whether they fulfil the criteria for a surgical intervention. 

In the history we will focus on: 
  • how long the symptoms are present, 
  • distribution of the symptoms between day and night, 
  • impact of the symptoms and pain on activity and rresting, 
  • need for a walking aid and 
  • the regular use of painkillers. 

Examination we will be looking for: 
  • deformity, 
  • swelling, 
  • tenderness, 
  • reduction in range of movement and 
  • fluid in the joint. 

Almost every patient suspecting knee osteoarthritis really requires standing radiograph of a knee in two views.  

If extent of damage of the cartilage will not be clear, MRI Scan will be requested. 

CT scan will only be requested for a patient with existing deformities for pre-op planning. 

Profound engagement of the patient in the process will be expected and requested.

If patient will not fulfil the criteria for operative management they will be offered continuous support with all non-operative measures including advice, exercise, the Weight loss, manual therapy, Oral medication, injection therapy and braces. 


If patient is undecided a follow-up appointment can be offered usually in 6 to 12 months. 

In our opinion decision to have the surgery is dynamic process and can always be postponed, delayed or reinstatement. 

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  • Home
    • Knee Surgery >
      • Symptomatic Osteoarthritis of the Knee >
        • Primary Care >
          • Initial Management
          • Intermediate Care
          • Referral Treshold
        • Secondary Care >
          • Total Knee Replacement
          • High Tibial Osteotomy
          • Knee Arthroscopy
          • Complex Primary Total Knee Replacement
          • Postoperative Management
        • Procedures recommended by NICE
        • Procedures with limitations by NICE
        • Procedures not recommended by NICE
        • Viscosupplementation
      • Trauma to the Knee >
        • Meniscal Injuries
        • ACL Injury
      • Partial v Total Knee replacement
    • Limb Lengthening >
      • Femoral lengthening over the nail
  • Orthopaedic Trauma
    • Complex Trauma Impact
    • Principles of fine wire frame fixation >
      • Indications for fine wire frame
      • Complications >
        • Predictable complications
        • Unpredictable complications
      • Pin sites management
      • Activities >
        • Videos
        • Photos
    • Poller or Blocking screw >
      • Mechanic of Poller screw
      • Without and With a Poller Screw
      • Third Generation Poller Screws >
        • Epicentric poller screws in osteoporotic bone
        • Epicentric poller screws in comminuted spiral fracture
      • Use of Poller Screw(s) in Complex Cases >
        • Segmental Femoral Fracture
        • Low Supracondylar Femoral Fracture
        • Low Supracondylar Femoral Fracture 2nd case
        • Femoral Non-union - Antegrade Nail
        • Femoral Non-union - Retrograde nail
        • Distal Tibia Spiral Fracture
    • VAC irrigation
    • Complex Cases >
      • Femoral diaphysis defect
      • Capitellum Fractures
      • Distal Femoral Fractures
      • Proximal Humerus Fractures
      • Subtrochanteric Femoral Fractures
  • Osseointegration
    • Osseointegration-Physiotherapy
    • Osseointegration-Surgery
    • Osseointegration-NHS Perspective
  • Medico-legal
    • PI Solicitors
  • Blog
  • Contact
    • About
    • CV