The Hip Bone’s Connected to the Knee Bone—and the AI Knows It, Too.
Woe be the surgeon who operates on the knee when the hip is the problem.
This adage has been taught to medical students from the early days, but unfortunately forgotten later in life. Patients with knee pain sometimes have hip arthritis that refers to (i.e., is experienced as) pain only in the knee. Patients with hip pain sometimes have back issues that refer to pain in the hip. The human body is interconnected, and pain is a tricky symptom.
The first step toward figuring out where a person’s pain is coming from is a careful history. Most of the time an experienced doctor knows the diagnosis within the first 30 seconds of talking with a patient. Yet often, the physical exam that follows reveals surprises. When we examine a patient’s knee after a sports injury, for example, the first thing we look at is the range of motion of their hips. Why? Because sometimes the injury occurred because the hip motion was limited. At other times, a concurrent hip problem exists that will limit the success of the knee surgery repair.
The same is true for their ankle, feet, back, and joint ranges of motion. Watching a patient walk and run up and down our clinic’s hallway is our first screening tool. For patients with chronic problems—especially arthritis of various joints—their gait tells much of their story. The limp that may occur only when running, the hitch in their gait when they are walking, or their tilt to one side or the other; these reveal the compensations they are making to get around their painful or stiff joint. But fixing the joint is only one part of the approach. Rehabilitating the patient with an all-around fitness program focused on regaining the muscle power necessary to walk and run with poise is just as important.
As a further asset, those aggravating questionnaires that doctors make patients fill out are actually turning out to be quite useful. In the past, many of them were just filed away. Today, with AI, we can incorporate the patients’ forms into their oral histories in far more efficient and effective ways to highlight areas of concern that may be overlooked during the physical examination.
By next year, most patients will go to a physician’s office where both the doctor and the patients are empowered by AI. A Siri-like voice agent will listen to the patient’s history. The AI will remind the patient about the symptoms and past facts they are forgetting about, and the doctor will have the world’s medical knowledge listening along. When these two sources of information are combined with a careful physical exam—and the experience and wisdom of a concerned physician—the experience of being a patient will be elevated to an entirely new level.
The basics of history-taking, a physical exam, X-ray, and MRI images remain at the core of good orthopaedic medicine. And the desire to push science forward, improving both our skills and our patients’ outcomes, marks the curious physician. The emergence of AI tools is poised to empower both patient and provider. Add a great rehabilitation and fitness team to injury care and the outcomes can be better than merely good. Combine all these and every injury becomes an opportunity to become fitter, faster, and stronger.
