Which Specialist to See for Knee Pain: Orthopedics or Vascular Surgery?

Should I see an orthopedic surgeon or a cardiovascular surgeon?

My mother has recently been experiencing knee pain, but sometimes she feels it may be related to her leg veins, as the pain is not localized and seems to move around like it’s following the blood vessels.
We consulted an orthopedic specialist who, after taking X-rays, indicated that her bone degeneration is quite severe.
However, after taking medication and receiving pain relief injections, there has been no improvement in her symptoms.
We then visited a pain management clinic where the doctor prescribed medication and injections aimed at improving blood circulation, but after several visits, her symptoms have not improved.
The physician at the pain clinic suggested that varicose veins might be a contributing factor, so we also consulted a vascular surgeon.
That doctor noted that her varicose veins are quite severe and mentioned that even surgery might not guarantee improvement, so we left it at that.
Recently, her pain has worsened to the point where she sometimes has difficulty walking.
Could you please advise which specialty we should consult? What could be the underlying issue with my mother’s condition? Thank you.
(My mother is 57 years old and is currently taking supplements to help slow down her degeneration.)

Fiona, 20~29 year old female. Ask Date: 2007/04/11

Dr. Xu Kaixi reply Surgery

Dear Fiona,
This is Dr.
Hsu Kai-Hsi from the Tainan Hospital of the Department of Health, Executive Yuan.
Based on the description in the article, there are at least two significant issues: severe bone degeneration (possibly osteoarthritis) and severe varicose veins, both of which may be associated with pain and should be continuously monitored and treated by orthopedic and vascular surgeons.
Since the efficacy of medication control seems to be inadequate, surgical intervention may be considered (to be evaluated by the relevant specialists).
Additionally, other common causes of lower limb pain include herniated discs compressing nerves, vascular inflammation, and thrombosis.
I recommend further evaluations by neurosurgery and vascular medicine specialists.
The surgical team at Tainan Hospital is concerned about you and wishes you all the best.

Reply Date: 2007/04/11

More Info

When it comes to knee pain, especially in a case like your mother's, it can be quite complex due to the interplay of various factors, including orthopedic issues and vascular conditions. Given the history you've provided, it seems that your mother has been experiencing significant discomfort, and the pain appears to be multifaceted, possibly involving both joint degeneration and vascular issues.

Understanding the Symptoms
1. Knee Pain and Osteoarthritis: The X-ray findings indicating severe degeneration suggest that your mother may be suffering from osteoarthritis, a common condition that affects the knee joint as people age. This condition can lead to pain, stiffness, and decreased mobility. The pain associated with osteoarthritis is typically localized around the knee joint but can sometimes radiate to other areas.

2. Vascular Issues: The description of pain "moving around" and being associated with her legs could indicate a vascular component, such as venous insufficiency or varicose veins. These conditions can cause pain, swelling, and discomfort, particularly after prolonged standing or sitting. The fact that the pain has not improved with orthopedic treatment suggests that there may be more than just a degenerative joint issue at play.

Which Specialist to See
Given the complexity of your mother's symptoms, it may be beneficial to consult with both an orthopedic specialist and a vascular surgeon. Here’s a breakdown of what each specialist can offer:
- Orthopedic Surgeon: This specialist focuses on the musculoskeletal system, including bones, joints, ligaments, and tendons. They can provide treatments for osteoarthritis, such as physical therapy, medications, injections (like corticosteroids or hyaluronic acid), and possibly surgical options if conservative treatments fail. Since your mother has already seen an orthopedic doctor, it might be worth seeking a second opinion, especially if her symptoms have worsened.

- Vascular Surgeon: If there is a suspicion of vascular issues, a vascular surgeon can evaluate the blood flow in the legs and determine if conditions like chronic venous insufficiency or deep vein thrombosis (DVT) are contributing to her pain. They can perform tests such as Doppler ultrasound to assess blood flow and may recommend treatments ranging from lifestyle changes and compression stockings to surgical interventions if necessary.

Next Steps
1. Comprehensive Evaluation: It may be beneficial for your mother to undergo a comprehensive evaluation that includes both orthopedic and vascular assessments. This could involve imaging studies (like an MRI for the knee and an ultrasound for the veins) to get a clearer picture of what is happening in both the joint and the vascular system.

2. Multidisciplinary Approach: Consider seeking a multidisciplinary clinic where both orthopedic and vascular specialists work together. This can ensure that all aspects of your mother's condition are addressed in a coordinated manner.

3. Physical Therapy: Regardless of the specialist, physical therapy can be an essential part of recovery. A physical therapist can help strengthen the muscles around the knee, improve mobility, and potentially alleviate some of the pain.

4. Pain Management: Since your mother has not found relief with current medications, discussing alternative pain management strategies with a pain specialist may also be beneficial. This could include options like nerve blocks, physical therapy modalities, or even newer treatments like regenerative medicine.

Conclusion
In summary, your mother's knee pain could stem from both orthopedic and vascular issues, and it is crucial to address both aspects for effective management. A collaborative approach involving both orthopedic and vascular specialists will likely yield the best outcomes. Encourage your mother to continue seeking help until she finds a treatment plan that alleviates her pain and improves her quality of life.

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