Lam Stephen, Amies Victoria
Department of General Surgery, James Paget Hospital, Great Yarmouth, UK.
Department of General Practice, Watton Medical Practice, Norfolk, UK.
BMJ Case Rep. 2015 Feb 19;2015:bcr2014208625. doi: 10.1136/bcr-2014-208625.
A 68-year-old man with a history of left total knee replacement presented to his general practitioner with left knee pain. He reported pain onset after a fall in the garden. An X-ray of the knee was arranged but showed no abnormality to explain the pain. He was treated with simple analgesia. However, he reattended with the same knee pain. A further X-ray of the knee was requested, but again showed no abnormality. On his fourth presentation in 6 months, a further musculoskeletal examination was undertaken. This time the hip was also examined and showed that maximal pain was in fact on rotation of the hip joint. A subsequent X-ray of the hip showed severe osteoarthritis of the left hip with complete joint space loss and flattening of the femoral head. The patient was referred to an orthopaedic surgeon for a left hip replacement.
一名有左膝全膝关节置换史的68岁男性因左膝疼痛就诊于他的全科医生。他称疼痛在花园摔倒后开始。安排了膝关节X线检查，但未发现异常来解释疼痛。他接受了简单的镇痛治疗。然而，他因同样的膝痛再次就诊。再次要求进行膝关节X线检查，但仍未发现异常。在6个月内的第四次就诊时，进行了进一步的肌肉骨骼检查。这次也检查了髋关节，结果显示最大疼痛实际上是在髋关节旋转时出现的。随后的髋关节X线检查显示左髋关节严重骨关节炎，关节间隙完全消失，股骨头扁平。该患者被转诊至骨科医生处进行左髋关节置换。
