JOCD Cases Archive - Orthopaedic Academy

There should be a high index of suspicion
It is important to consider other causes of symptoms
Think outside the box if the picture doesn’t add up (severity of pain versus x-ray findings in the knee)
Common things occur commonly (Hip Osteoarthritis)!
Always do a pelvic x-ray in patients with Knee pain
Avoid assumptions and pre-conceptions about diagnosis
Always listen to the patient and consider what they know or have been told before (GP informed the patient that she needs a TKR)
If in doubt, consider second opinion from a colleague or MDT.

Unusual Case of Persistent Hip and Leg Pain

Maintain vigilance when hip pain presents with a normal X-ray — the pathology may be extra-articular or systemic in origin.
Keep a broad differential diagnosis and a low threshold for investigating atypical causes of hip and leg pain.
Listen carefully to the patient’s history — subtle details often provide diagnostic clues.
Do not underestimate disproportionate or persistent pain, as it may signal serious underlying pathology.
Perform a comprehensive clinical examination, including assessment of the spine and adjacent joints.
Always examine the joint above and below the site of reported pain to avoid diagnostic oversight.
Consider advanced imaging (e.g. MRI of the pelvis and lumbar spine) when initial investigations are inconclusive.
Adopt a multidisciplinary approach — refer appropriately (e.g. to gynaecology or other specialties) when non-orthopaedic causes are suspected.