13 2.1 Case Presentation 2.1.1 History and Physical A 69-year-old female presented to clinic with the chief com- plaint of several years of progressively worsening bilateral knee pain, right greater than left. There was no specific incident that started the pain. On the right side, she felt the pain throughout the whole knee, worst on the lateral aspect. She stated the pain was worse with activity, especially with climbing stairs, and relieved by rest; the patient described the pain as sharp with activity but dull/achy at rest. The patient was initially treated with activity modification, physical therapy, and daily NSAIDs, which sufficiently man- aged the pain for several years. However, the pain continued to worsen, and the patient subsequently received several intra-articular corticosteroid injections. The first one pro- vided relief for several months, but the last injection only Chapter 2 Complex Primary Total Knee Arthroplasty: Management of Valgus Knee Jon O. Wright and Ryan M. Nunley J.O. Wright, BS • R.M. Nunley, BA, MD () Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, MO, USA e-mail: nunleyr@wudosis.wustl.edu © Springer International Publishing Switzerland 2015 B.D. Springer and B.M. Curtin (eds.), Complex Primary and Revision Total Knee Arthroplasty: A Clinical Casebook, DOI 10.1007/978-3-319-18350-3_2