History of Present Illness
Exact location of pain (knee compartment, groin, etc), radiation, numbness, how long has it been there, severity, presence or absence of mechanical symptoms (catching, clicking, locking), interruption in ADL, what makes it better/worse, previous injections, ability to don and doff shoes, ability to take public transportation, previous surgeries to that area.
Past Medical History
Any heart, lung, liver, kidney problems. Diabetes, gout, RA, bleeding problems.
Medications
Especially anticoagulants, rheumatoid agents, NSAID’s, glucosamine
Allergies
Social History
Tobacco and EtOH use. Substance abuse, hobbies, work, help at home.
Family History
ROS
Physical Exam
Examine both hip and knee whether the complaint is hip or knee pain. Always look at patients feet and get a good neurovascular exam (pulses, distal perfusion, toenail changes, sensory exam [especially pernoneal (FDWS) and tibial (heel) nerve distributions], motor function), overlying skin changes, low back pain, straight leg raise test, swelling.
Body mass (obese, thin), gait exam
Hip ROM, pain with internal rotation (any specific position that exacerbates or reproduces pain), catching/locking with movement, leg lengths, overlying scars,
Knee ROM, palpate joint line, patellofemoral grind, Lachman test, posterior drawer, varus/valgus stress, crepitus, overall alignment, previous incisions and their locations
Radiographic Exam
Get standing AP, Lateral, Sunrise, PA 45 degree flexed (to see wear of posterior condyles). Joint space, osteophytes, subchondral sclerosis, cysts, alignment, bone loss, deformity
A/P
Try non-operative treatment first (Tylenol, NSAID, glucosamine, injections, weight loss, etc). When non-op treatment fails and symptoms impairing activities of daily living, next step with severe arthritis is total joint. If injury present and mechanical symptoms only, consider MRI and possible arthroscopy and debridement.