Mr. R is an 88 year old male who was treated Pro Bono, on a medical mission trip in the country of Honduras. He was 2 ½ years status post Right hip surgery, with very poor surgical outcome. He reported through our interpreter, that although his hip was very stiff, he had almost no pain in hip after surgery.
He was now suffering from severe, constant pain in Right knee, with stiffness. His past medical history was positive for hypertension and multiple farm related injuries over his long working life. Surgical history was only positive for the “bad surgery” for his right hip.
He had tried pain pills (paracetamol), rest, heat, massage and cortisone injections for his incapacitating knee pain that only began to significantly bother him after his hip surgery.
Foot note : It is very common for one or more other in line joints to begin bothering a patient after one joint that is in line with the surgical site.
Physical exam revealed an 88 year old male who was frail and thin and walked haltingly with extreme pain in his facial expression. His posture showed he was leaning toward the right knee and was forward flexed at the waist.
It took him about four times as long as other patients to walk down the hall and get onto my examination table.
The right hip revealed a very large scar , with enormous stitch marks and a shiny appearance. Range of motion of the hip was almost zero, but there was a bit of flexion, no extension and no rotation. Leg length comparison showed that the right leg (surgical side) was approximately 1 and ¼ inches shorter than his left leg. Because of this discrepancy, he was putting tremendous pressure on his right knee.
The right knee showed obvious enlargement circumstantially compared to the left knee, indicative of severe degenerative joint disease or Osteoarthritis. There was about 5 to maybe
10 degrees of flexion with extreme pain when passively examining the knee. There was crepitus with each movement of the knee.
The patient could not , or would not bend the knee on his own accord due to pain and loss of range of motion. There was no joint effusion or swelling. The anterior drawer test was negative, but the posterior drawer test was slightly positive, indicating posterior cruciate ligament damage.
This was a very difficult case to determine how we could move forward in helping the patient, since we could not reverse his hip surgery or even do injections there since he apparently had surgical hardware and implants in the hip.
- Pain Location