No healthcare; help greatly appreciated

Thanks for reading. 11 years ago, when I was 22, I received a total hip replacement for my right hip. I needed the hip replacement because I developed avascular necrosis due a break of my femoral neck that I suffered after taking a 50' fall. Immediately after my fall, the femoral neck was pinned together. 9 months after the accident, I began to experience pain in my right hip (as the undiagnosed avascular necrosis was progressing), yet continued to walk with increased pain for 6 months as the condition worsened. My leg shortened as the femoral head deteriorated, and my right knee began to hurt (particularly in the upper anterior area, just medial to the patella- I think the sartorius muscle was involved). After my problem was diagnosed and i received the hip replacement, the knee pain mostly subsided, though it would come back at certain times, particularly when driving for extended lengths of time (cruise control was a godsend).

Over the course of the next 10 years, I thoroughly enjoyed the benefits of my new hip: trekking in the Himalayas in Nepal, taking extended daily walks, and dancing up a storm whenever I could. A year ago I enrolled in a Hip-Hop aerobics class which included VERY high impact exercises. I knew better than to take part because of my hip, but I did it anyway. I quit when my right knee began to ache after class. This was a dull ache in the back of my knee, not acute, but spread out. It was deep and posterior and generalized. Then I noticed, more and more, that that same posterior and deep area would hurt (generalized pain) when standing up from a squat.

Three weeks ago, while walking, my right knee pain became severe. I don't know what happened, but all of the sudden, I could barely walk on it. I RICED it for 4 days and then walked with a cane for a couple of weeks. Now, three weeks later, it is not back to normal. It will tire and ache with prolonged activity, and feels unstable (like I could really hurt it if I were to twist it the wrong way). I have no health insurance and feel pretty lost and scared about this situation. If I am going to pay out of pocket for orthopedic care, I want to make sure I get the most for my money. I need to get diagnosed so I can figure out if I may need surgery, and then go about crafting a way to get health coverage (I am a working artist and massage therapist living in Connecticut, USA). It's also been 11.5 years since my hip replacement surgery, and I know I will need health coverage soon because of that anyway (though I'm hoping for 20+ years from this hip )

Does anyone have an idea of what the problem might be? Also, what is the most direct (and inexpensive) way i can get my situation diagnosed?

Thank you so so very much for reading my lengthy description. I am grateful for your help.

[S. Kaul, MD]

Hi there!

Well, without an evaluation it would be difficult to identify the cause of knee pain in your case. Possibilities include chondromalacia patellae, tendonitis, bursitis, fractures, patellar dislocation, injuries to the internal knee ligaments/ menisci, infections/ inflammations, arthritis, cyst formation, bone growths/ tumours, nerve injuries etc; just to name a few. The investigations required, would need to be decided on a primary physical examination depending on the cause suspected. I would suggest consulting an orthopedician for an evaluation and appropriate management. Meanwhile you may try resting the knee with some OTC NSAIDS to relieve the pain.
Hope this is helpful.

Take care!