Orthopedic Oncology, Oncology
Ref. # 73618
A 46 year old West Virginia woman consulted her family physician due to right knee pain. He ordered X-rays, which hospital radiologists interpreted as showing narrowing of the medial compartment with no definite acute bony abnormality. The F.P. interpreted the X-rays as showing a tiny spot suggesting irritation or arthritis. He diagnosed a possible ligament sprain and prescribed Anaprox. The patient complained periodically of severe knee pain during several visits to the F.P. over the next eight months. He referred her to an orthopedic surgeon, who diagnosed patella femoral irritation. Treatment consisted of Daypro, bracing and physical therapy for five months, despite the patient's continued complaints of pain during periodic examinations. The orthopedic surgeon then ordered X-rays, which suggested osteogenic sarcoma of the distal femur and knee joint. The patient was referred to an oncologist, who performed a biopsy which confirmed osteosarcoma, malignant fibrous histiocytoma subtype, group 3. She required chemotherapy, followed by surgery that included a wide resection of the distal femur and fusion of the knee joint. A medQuest orthopedic oncologist opined that the orthopedic surgeon negligently failed to order X-rays upon first examining the patient, which would have led to an early diagnosis. Timely treatment would have lessened the risk of metastatic disease and minimized the extent of the required surgery.