Michael C. Ciccotti, MD

An 81-year-old woman presented to our clinic with a chief complaint of left hip pain and inability to bear weight. She had undergone left total hip arthroplasty revision surgery 6 weeks previously to address polyethylene wear of her index THA performed 20 years prior to presentation. The patient was noted to have a protrusio prior to her revision surgery with violation of the medial wall, however her revision surgeon was able to perform an appropriate acetabular revision by using a multi-hole shell. During her rehabilitation from that surgery, the patient sustained a fall and subsequently developed severe left hip pain with any attempt at weight-bearing. She was subsequently referred to our practice for further evaluation and management.

A 63-year-old woman developed persistent, insidious, atraumatic low back and right posterior thigh pain. She was seen by her primary care physician and, in the absence of red flag symptoms, was diagnosed as having sustained a herniated lumbar disc with associated radiculopathy/sciatica. Plain radiographs of the lumbar spine were negative and given her lack of motor or sensory findings, no advanced imaging was ordered. She was treated with NSAIDs and prescribed a course of physical therapy. Despite compliance with treatment, her symptoms failed to resolve. She was subsequently treated with an escalating course of oral steroids, anti-spasmodic medication, and lidocaine patches. After at least 2 months of such treatment, her symptoms were severe enough to warrant a visit to the ED, although she was discharged home after evaluation by the emergency physician.

A 13-year-old male patient presented approximately 2 weeks after he sustained an atraumatic, left knee injury while playing basketball. The injury occurred when the patient was pivoting and shooting. He was unable to precisely identify when he first felt a pop within his knee. The patient developed acute left knee swelling. Although able to tolerate weight-bearing, he had discomfort and felt an occasional clunk with knee flexion/extension. The pain was predominantly described as involving the lateral aspect of the knee. He was initially seen at an urgent care facility in the days following his injury and was then seen by a local orthopedic surgeon before he presented to our clinic for second opinion.