Knee Pain

[munish124]

My mother is 58 years of age. She has pain in her left knee for almost last one year and this leg is swollen for same period. We consulted various doctors (including ortho.) but there is no improvement. X-ray was done and she has been treated by doctors for crack in skin and infection, but there is no improvement. She can not put her full weight on right leg and can not move on stairs.
There is small history of one injury in her legs. She felt down some two years back and there was internal injury on both of her knees and skin color was turned to blue for 6-7 days. After this injury she started feeling some uneasiness in her knees and felt them soft. Doctors then removed some liquid from right knee and till few days back right leg was fine. But for last 15 days, pain has also started in her right knee.She was continuing feeling some movement and uneasiness in her knees.
There is also pain in her ankles and forefoot. These parts normally remain numb.
Now both legs have same type of pain and uneasiness.
Request you to advice on same.

[DrNoopurMD]

Hi,

Thanks for posting.
It is important to know what the findings of the X ray were. Also at this point a repeat X ray of both the knees and an orthopedic evaluation is warranted.
There can be many causes of knee pain like arthritis, bursitis, meniscal injury, and tendinitis and nerve compression.
I will urge you to get her orthopedic evaluation done at your earliest.

[abhijeet v ghosh]

hello munish,
one good this which i noticed in this posting is that, you have not mentioned anything related to fever. SO infection is ruled out.
Her age and a history of injury points towards reactive arthritis secondary to osteoarthritis. The best treatment, presently for Osteoarthritis , is Total knee replacement.Can you upload her knee X-rays on the photo section, so that i will be able to comment on that.
any querries, do ask me,
regards
abhijeet

[caregiver222]

Fever is not necessarily co-incident with many low-grade infections. So infection is unlikely, but not ruled out.

Culture of the fluid extracted would be a good first step.

An x-ray is a good idea, but an MRI of the knee is better. I would also ask for an MRI of the foot.

And I would not necessarily head for the conclusion that a total knee replacement is necessary.

I am concerned about the constellation of symptoms, particuliarly the pain in the ankles and forefoot. Arthritic pain is not relieved by extraction of fluid.

The comment "treated for crack in skin" and "infection" intrigued me.

We have swelling in several areas, and the pain, in such instances, is generally caused by such swelling impinging on nerves.

My question is what kind of fluid is building up?

I think you should get a tuberculosis test. While TB is typically associated with the lung, you can get these infections anywhere.

Infections in the legs can become encapsulated and become difficult to get rid of because oral antibiotics do not travel well to the lower extremities.

Pain in the ankle and forefoot of one leg is not typical of systemic arthritis. These are focal findings.

The numbness is another issue that concerns me.

A question you should ask your physician is "why is there numbness".

I would also get a vascular consult and a doppler of both legs.

As Dr, Nooper stated minescal injury and nerve compression come to mind as a first guess.

There are a lot of missing pieces here.