Knee pain with no obvious x-ray or physical exam findings should bring up a red flag to automatically check the hip. It is well known and taught in medical schools, that the same nerve-the obturator nerve-innervates both joints. Therefore, an elderly patient commonly can present to an emergency room complaining of knee pain after a fall. Then after emergency room physician review of x-rays showing a knee without any acute fractures, the patient is sent home only to return the next day with complaints of hip pain with x-rays showing a displaced hip fracture requiring a major operation. The standard of care in this situation would be to both examine the hip and to x-ray the hip at the first presentation.
Additionally, there are known cases of patients having total knees performed in patients who were complaining of vague knee pain and having mild to moderate arthritis on x-rays, only to discover that afterward the patient still had knee pain and then hip x-rays revealed severe end-stage arthritis. The patient then required a total hip arthroplasty. The standard of care here also would be to take a detailed history of the pain pattern and to x-ray the hip on the same side.
Not adhering to the standard of care for evaluating these two examples of hip conditions would clearly indicate negligence and malpractice.
The expert who prepared this article is a Board Certified Orthopedic Surgeon with 34 years of continuous and full-time practice. For these 34 years, he has performed hundreds of both primary and revision type total knee and hip arthroplasties.