Intended for healthcare professionals

Endgames Case Review

Not a typical case of bilateral knee osteoarthritis

BMJ 2016; 352 doi: (Published 06 January 2016) Cite this as: BMJ 2016;352:i39
  1. Morteza Khodaee, associate professor1,
  2. Jonathan Seyfert, house officer1
  1. 1AFW Clinic, Family Medicine, University of Colorado School of Medicine, Denver, CO, USA
  1. Correspondence to: M Khodaee morteza.khodaee{at}

A 64 year old woman presented to our clinic with intermittent bilateral knee pain for several years. She described her pain as mild, diffuse, both improved and worsened with walking, and occasionally associated with a sensation of instability. Although she had no history of trauma, mechanical symptoms such as locking, interference with daily activities, or pain in other joints, she did have osteoarthritis of the knee and osteoporosis. Several years earlier she had received a corticosteroid injection in her left knee but had never undergone imaging of her knees. Recently, she had been using paracetamol (acetaminophen) and naproxen as needed for the pain.

Physical examination showed bilateral genu valgum with bilateral diffuse tenderness to palpation along her joint lines and patellar facets. Bilateral patellar movement caused considerable crepitus and discomfort. She had a small joint effusion in her left knee but not on the right. She had decreased flexion of the knees—110º on the left and 100º on the right. Her gait was mildly antalgic bilaterally. Plain radiography was performed (fig 1).

Fig 1 Anterioposterior plain radiograph of bilateral knees


  • 1. What do the radiographs show?

  • 2. What is the diagnosis?

  • 3. What are the treatment options?

  • 4. What to do next?


1. What do the radiographs show?

Short answer

Multiple calcified bodies of various sizes distributed throughout the knee joint and severe bilateral tricompartmental knee osteoarthritis.


The multiple calcified bodies of various sizes probably developed at different times. These …

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