Severe bilateral medial compartment collapse of the knees

The patient is a very pleasant 87-year-old female who presents with her son today for evaluation of bilateral knee pain. She has been seen by orthopedic surgeon, and has been told she is not a surgical candidate for her knees due to her advanced age. She underwent a series of injections which appeared to be fluoroscopically guided and this was approximately one-year ago. It helped significantly for her right knee pain. Unfortunately, she then had abdominal surgery for gastric ulcer and then her knee began to hurt afterwards after some therapy was performed. She presents today with the use of a wheeled walker for evaluation and consideration of viscosupplementation protocol.

ASSESSMENT:
This is an 87-year-old female with severe bilateral knee pain who has been deemed a nonsurgical candidate per an orthopedic surgeon. She presents today for evaluation and requests viscosupplementation protocol as she had this done one year ago

IMPRESSION:
Severe bilateral medial compartment collapse of the knees.

PLAN:
I had a very lengthy visit with the patient and her son today. It appears that the injections she had one year ago were under fluoroscopic guidance and that would be optimal based upon her x-rays that are reviewed today. I am fine with moving forward with viscosupplementation, but I do feel that unloader bracing plus physical therapy plus regimented viscosupplementation with or without glucocorticoid would be the most appropriate at this point. I made it very clear to the patient and her son that they in nowhere these injections or therapy is curative, but since she has no surgical option, she would need to maintain in any way possible.

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