Q: A patient came he got surgery in leg before 40+ years and he calms pain from 1 year ago little bit and he told when I walk i fell more pain A: Thanks for sharing this. From your description and photo, this looks like a large swelling around the knee/thigh area with pain that increases on walking. In someone with old surgery 40+ years ago, this needs urgent in-person orthopedic evaluation. I cannot diagnose from image alone, but important possibilities include: - Chronic fluid collection seroma/bursa - Old implant-related problem if any metal was used - Knee joint effusion/severe arthritis - Soft tissue mass including tumor, benign or serious - Less commonly infection even late or vascular/lymphatic swelling What to do now 1. Refer urgently to Orthopedic surgeon preferably today or within 24-48 hours. 2. Required tests: - X-ray of knee/femur AP/Lateral - Ultrasound of swelling solid vs fluid - MRI with contrast if mass is unclear - Basic labs: CBC, ESR, CRP, renal function 3. If fluid collection is suspected, aspiration should be done by specialist under sterile conditions send for culture/cytology as needed. Red flags go to emergency immediately - Fever, redness, warmth over swelling - Rapidly increasing size - Severe pain at rest/night pain - Inability to bear weight - Numbness, weakness, cold foot, or color change - Unexplained weight loss Temporary care until seen - Rest, avoid long walking/weight-bearing - Elevate leg - Simple pain medicine if safe paracetamol/acetaminophen - Do not massage, press, or puncture the swelling If you want, I can help you write a short clinical note/referral format history, exam points, and investigations to use with the orthopedic team. Q: Yes A: Use this referral note format: Orthopedic Referral Note Patient: Name / Age / Sex Date: dd-mm-yyyy Chief complaint - Swelling and pain in right/left knee-thigh region for about 1 year - Pain is worse on walking / weight-bearing Relevant history - History of surgery on same leg about 40+ years ago details unknown/known: - Onset of current swelling: gradual / progressive - Pain nature: dull / sharp / constant / intermittent - Any increase in swelling size: yes/no - Night pain: yes/no - Fever/chills: yes/no - Redness/warmth: yes/no - Trauma recently: yes/no - Weight loss/appetite loss: yes/no - Numbness/weakness in leg/foot: yes/no - Comorbidities: diabetes / HTN / others: - Drug history/allergy: Examination to fill - Vitals: BP HR Temp - Local exam: - Site: anteromedial/anterior/lateral thigh-knee - Size: cm × cm - Surface: smooth/irregular - Consistency: soft/firm/fluctuant - Tenderness: present/absent - Local temperature: raised/not raised - Skin changes/scar/sinus: - Mobility/fixity: - Transillumination if relevant: - Knee ROM: flexion , extension , painful arc - Distal neurovascular status: - Pulses DP/PT: present/absent - Sensation: intact/reduced - Motor power: /5 Provisional concerns - Chronic post-surgical swelling with mechanical pain - Rule out: 1. Chronic fluid collection/bursitis/hematoma 2. Implant-related late complication if implant present 3. Joint effusion/advanced OA 4. Soft tissue tumor benign vs malignant 5. Chronic infection less likely but must exclude Suggested investigations 1. X-ray knee + distal femur AP/Lateral 2. Ultrasound local swelling 3. MRI with contrast of thigh/knee if diagnosis unclear or mass suspected 4. Labs: CBC, ESR, CRP, RFT, LFT, blood glucose 5. If fluid/mass confirmed: image-guided aspiration/biopsy for culture, cytology/histopathology Immediate plan - Limit weight-bearing, analgesia, limb elevation - Urgent orthopedic review - Emergency if red flags: fever, rapid growth, severe rest pain, inability to walk, neurovascular deficit --- If you want, I can also give you a very short OPD version 5-6 lines for quick writing in a busy clinic.
