MEDICAL MYSTERY FOR CHAPTER 3: MARYMary is a married woman with three grown children. She has just quit her job as a receptionist because of poor health. For the last few years, she has found it very difficult to walk up the stairs at work. She also noticed that her right knee was quite painful and swollen at times. The daily trip to work on the subway, negotiating the bustling crowds, was too much for her knee. At home, she noticed that her knee felt okay when she did not walk much. However, at night she continued to feel some pain in her right knee and often required pain medications in order to sleep. She tried several home remedies, including applying garlic paste, warm compresses, and even Chinese herbs on the knee. As time went on, she became more disabled. Every time she walked, she felt that her knee might give out. She tried to use a cane, but the pain was still unbearable at times. She wanted desperately to lose some weight, yet she couldn’t really exercise. Her sister told her that she should try some calcium and vitamin supplements to strengthen her bones.THE EVALUATIONMary’s husband finally convinced her to come to my office. She was always afraid of doctors and had been very reluctant to come. She was also fearful that she might have rheumatoid arthritis, which had crippled her best friend Sadie. But she decided that the pain was just too much and couldn’t put off a visit to the doctor any longer. I examined Mary and found that her right knee was swollen and painful to the touch. It also seemed very unstable. I ordered some x-rays and prescribed pain pills. I gave Mary a referral to an orthopedic surgeon and suggested that she use a walker in the meantime to prevent a fall.THE DIAGNOSISAfter reviewing the x-rays of her knee, the orthopedic surgeon told Mary that she has developed osteoarthritis of the knee. He explained to her that this was basically a degenerative process and the fluid in between the joints had completely disappeared. The friction between the two joints was causing the pain and destroying her joint. She was very relieved when he told her that her other knee was fine.THE TREATMENTThe surgeon confirmed that Mary had developed severe degenerative arthritis of her right knee and recommended total knee arthroplasty as the best option for her. One month later, she had the surgery, and she remained in the hospital for 3 days before being discharged to a rehabilitation center for 3 weeks of physical therapy. She also worked with a dietitian while in rehab. Mary’s postoperative course was unremarkable, and she was told that she should continue to watch her diet. It was also highly recommended that she maintain a regular regimen of physical activity.CASE CLOSEDMary came back into my office 6 months after her surgery and was walking unaided. She said that the recovery from the knee replacement had been a slow and sometimes painful process, but that she was now able to get around well enough to resume working part time. She looked much happier and healthier than when we first saw her, and she thanked our staff for making her feel at ease during her first appointment.Discussion QuestionsWhat is the most common cause of osteoarthritis?What is rheumatoid arthritis?What type of surgery is arthroplasty?Arthrodesis is a procedure sometimes used to treat severe arthritis or a damaged joint. What is this?