Bone ScanĪ bone scan is useful if hips and knees in looking for unexplained pain, occult fractures, osteonecrosis, occasionally osteoarthritis, tumours, and infection. They are not useful when looking at the cruciates, the collaterals, or menisci. The other indication is looking for a foreign body. The only time they are of use is when looking for a rupture of the extensor mechanisms such as in patient who can’t straight leg raise and you suspect may have a rupture of the patellar tendon or the quadriceps tendon. They are being ordered quite regularly and are generally of very little benefit. Ultrasounds are of very little benefit in the knee or the hip joint. CT scans are also useful looking at patellar tracking, in which case a special request needs to be ordered looking at different degrees of flexion, usually from 0-45 degrees. ![]() A CT Scanogram (to measure leg lengths) is of some limited benefit but a clinical examination is often more useful. It is not needed for arthritis or any soft tissue disorders such as meniscal tears or ligament ruptures. CT ScanĪ CT scan is occasionally ordered to look for bony abnormalities such as a fracture or a tumour. X-Rays are also useful for looking at calcification in the soft tissues including diagnoses such as Jumper’s knee, Osgood Schlatter’s disease, heterotopic ossification, myositis ossificans and chondrocalcinosis. In general, patients should have check X-Rays every one or two years depending on the type of joint and the age of the patient. The surgeon looks at alignment, the type of joint, wear, the patella (including the position and any loosening), loosening of the prosthesis or any loose bodies. Regular follow up X-Rays are necessary once a patient has had a joint replacement. In general, X-Rays look at the bony architecture, the mechanical alignment, any soft tissue swelling, effusions and fractures as well as other more rare disorders. ![]() The reason for X-Raying most patients is that occasionally there are surprising findings such as a tumour, loose body or foreign body which patients are not aware of (also stress fractures and developmental disorders). There are other special X-Ray views which will be done if it is noted noting on the request form that you are looking for a particular diagnosis. These will need to be asked for specifically on the x-ray request form. This is NOT as helpful as seeing the actual pictures themselves because Orthopaedic surgeons are looking for particular things that radiologists may not be aware of.įor a knee the standard set of X-Rays are a weight bearing AP (This should be an 18 inch film) a lateral, a notch view and a skyline patellar view. A number of patients bring an X-Ray report with them. ![]() Almost every patient who is referred to an Orthopaedic surgeon for a hip or knee problem should have an X-Ray. X-RayĪn X-Ray is the most important investigation and almost provides a large amount of useful information to the doctor. Not all patients will have the same investigations. Each of these have their own indication and are ordered for different reasons. There are a number of relevant investigations for hip and knee pain including: X-ray, MRI, bone scan, CT scan, ultrasound and other special scans.
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