78 years old male patient came to op with chief complaint of right knee joint pain since 25years

Hi, I am Y.Varunkarthik , 5th semester medical student. 

This is an online E-log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent. Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patients clinical problems with collective current best evidence based inputs.This e-log book also reflects my patient centered online learning portfolio and your valuable inputs on comment box is welcome. 

I've been given this case to solve in an attempt to understand the topic of "patient clinical data analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations and come up with a diagnosis and treatment plan.  

CONSENT AND DE-IDENTIFICATION : 
The patient and the attenders have been adequately informed about this documentation and privacy of the patient is being entirely conserved. No identifiers shall be revealed throughout the piece of work whatsoever.

Chief Complaint 
78 years old male patient came to op with chief complaint of right knee joint pain since 25years 

History of presenting illness
Patient was apparently asymptomatic 25 years ago ,then he developed

* Knee pain:
Since 25 years ,which is insidious in onset , intermittent, dragging type of pain, aggravated by walking, no relieving factors  

History of past illness 
K/c/o hypertension  since 15 years
K/c/o diabetes mellitus since 16 years
K/c/o asthma since 25 years
N/k/c/o epilepsy, tb, thyroid disorders
N/k/c/o blood transfusion
Met with accident 7 years back

Drug history - telmisartin 20 mg

Personal history
Married
Mixed diet 
Normal appetite
Adequate sleep
Regular bowel and bladder movements
Addiction: had a habit of consuming alcohol 20 years back

Surgical history
*Implantation of rod in left thigh
* fluid suction in right knee

General examination
Patient is conscious,coherent and cooperative
No pallor
No icterus
No cyanosis
No clubbing of fingers
No lymphadenopathy 
Pedal edema - pitting type 
Vitals 
Temp-afebrile
Pulse rate - 
Bp- 
Systemic examination
Cvs-S1&S2 are heard ,
no murmurs,
no thrills 

Respiratory examination - bae &NVBS are+ 

PA examination - no tenderness

Investigations

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