eMedicine Specialties > Orthopedic Surgery > Knee

Medial Compartment Arthritis: Workup

Author: Scott E Marwin, MD, Assistant Professor of Orthopedic Surgery, Albert Einstein College of Medicine; Associate Chair, Department of Orthopedic Surgery, Long Island Jewish Medical Center
Contributor Information and Disclosures

Updated: Sep 12, 2008

Workup

Laboratory Studies

  • Complete blood count and routine blood chemistries
  • Erythrocyte sedimentation rate (ESR), serum calcium levels, and phosphate levels
    • Elevated ESR, calcium, or phosphate levels may indicate the presence of an inflammatory or metabolic etiology of the arthritis.
    • These entities should be excluded prior to undertaking treatment for the medial compartment osteoarthritis.

Imaging Studies

  • Radiographs
    • Obtain anteroposterior (AP), lateral, and sunrise views of the knee. An additional posteroanterior (PA) view with both knees bent to 45° (Rosenberg view) can provide a great deal of information regarding joint space narrowing. These radiographs enable the surgeon to determine the presence and location of arthritis in the knee.
    • Stress views of the knee also may be helpful. By applying a varus or valgus stress, joint narrowing in the opposite compartment may be unmasked. This may alter the choice of surgical procedure. Alternatively, single leg standing long-leg radiographs (hip to ankle) may be obtained.
    • Obtain the hip/knee/ankle or 3-joint standing radiograph during the preoperative period. The radiograph must be taken with the leg in neutral rotation and with the legs bearing equal weight. Alternatively, the radiograph may be obtained with only the affected limb bearing weight. The mechanical axis may be measured from the 3-joint radiograph. A line from the center of the femoral head to the center of the talus forms the mechanical axis. This line should pass through the center or just lateral to the center of the tibial spines. In a varus-aligned limb, the line passes well medial to the knee.
    • Anatomic varus is represented by the angle that is formed by the intersection of the lines drawn through the long axes of the femur and tibia. Normal anatomic valgus is 5–7°
    • The measure of the dysplasia of the medial or lateral condyle of the distal femur also is important. The angle is formed by the intersection of a line passed through the femoral condyles and the long axis of the femur. The angle ranges 80-85° and is larger in varus knees.
    • Also, measure the angle formed by a line drawn across the tibial plateau and the long axis of the tibia. This indicates metaphyseal bowing and usually is 0-3° varus. The metaphyseal bowing offsets the slight mechanical varus angulation at the knee to provide a joint line that is horizontal to the floor.
  • MRI: MRI also may be considered to evaluate the ligamentous structures of the knee. However, ligamentous stability should be determined by physical examination. In addition, if the surgeon is considering concomitant cartilage resurfacing or replacement, a fat-suppressed T2-weighted image may assist the surgeon in determining if this surgical option is feasible.

Other Tests

  • Send the patient for appropriate medical clearance prior to any elective surgical procedure. The patient's primary care physician dictates if any further tests are necessary to clear the patient for surgery.

Diagnostic Procedures

  • Arthrocentesis
    • Arthrocentesis may be performed in the office. Indications for aspiration are for diagnosis or if infection is suspected.
    • Fluid aspirated from the knee may be sent for cell count, crystals, glucose, protein, Gram stain, and culture.
    • Arthrocentesis aids in differentiating a septic joint from a joint affected by gout or pseudogout. In cases of trauma, arthrocentesis relieves a tense hemarthrosis, and the blood aspirated can be examined to look for fat droplets indicative of an occult fracture.
    • Arthrocentesis has a minimal role in the diagnosis of medial compartment osteoarthritis but may be used to relieve symptoms of tense painful joint effusions.

More on Medial Compartment Arthritis

Overview: Medial Compartment Arthritis
Workup: Medial Compartment Arthritis
Treatment: Medial Compartment Arthritis
Follow-up: Medial Compartment Arthritis
Multimedia: Medial Compartment Arthritis
References
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References

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Further Reading

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Keywords

medial compartment arthritis, medial compartment osteoarthritis, knee arthritis, unicompartmental osteoarthritic knee, unicompartmental arthritis, arthritic knee, arthritis of the knee, degenerative arthritis of the knee, arthroscopic surgery, osteotomy, arthroplasty

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Contributor Information and Disclosures

Author

Scott E Marwin, MD, Assistant Professor of Orthopedic Surgery, Albert Einstein College of Medicine; Associate Chair, Department of Orthopedic Surgery, Long Island Jewish Medical Center
Scott E Marwin, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons
Disclosure: Nothing to disclose.

Medical Editor

Albert W Pearsall IV, MD, Associate Professor, Department of Orthopedic Surgery, University of South Alabama; Director, Section of Sports Medicine and Shoulder Service, Department of Orthopedic Surgery, University of South Alabama Medical Center
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Thomas M DeBerardino, MD, Director, John A Feagin, Jr, Sports Medicine Fellowship at West Point, Associate Professor of Orthopedic Surgery, Uniformed Services University of the Health Sciences and Keller Army Community Hospital
Thomas M DeBerardino, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Association, and American Orthopaedic Society for Sports Medicine
Disclosure: Arthrex, Inc. Grant/research funds None; Arthrex, Inc. Honoraria Speaking and teaching; Genzyme Biosurgery. Inc. Grant/research funds Other; Musculoskeletal Transplant Foundation Grant/research funds Other; Histogenics Grant/research funds None

CME Editor

Dinesh Patel, MD, FACS, Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital
Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Physicians of Indian Origin, American College of International Physicians, and American College of Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Carlos J Lavernia, MD, FAAOS, Adjunct Clinical Professor, Department of Orthopedic Surgery, University of Miami School of Medicine; Medical Director, Orthopedic Institute at Mercy Hospital
Carlos J Lavernia, MD, FAAOS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Hip and Knee Surgeons, Arthritis Foundation, Biomedical Engineering Society, Florida Orthopaedic Society, and Orthopaedic Research Society
Disclosure: Zimmer Stock Implant Designer

 
 
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