Avascular necrosis of the femoral head

Case contributed by Dr Chris Cadman

Presentation

Left hip pain

Patient Data

Age: 86

Radiograph of the pelvis (December 2014)

Modality: X-ray

Unremarkable pelvic radiograph for a patient of this age

Radiograph of the pelvis (December 2015)

There is generalised loss of volume of the left femoral head, which is positioned abnormally within the superior acetabulum, resulting in erosion of the latter structure.

Pelvic radiograph (January 2016)

Modality: X-ray

There is now complete necrosis of the femoral head, with the remaining femoral neck positioned abnormally within the superior acetabulum, resulting in erosion and sclerosis of both structures.

This series of hip radiographs demonstrates progressive and rapid loss of volume of the left femoral head without clear underlying pathology, in keeping with avascular necrosis.

Case Discussion

Avascular necrosis of the femoral head can occur at any age with risk factors including corticosteroid treatment, alcohol excess, obesity, scuba diving and sickle cell disease.

Insufficiency fractures within the subchondral bone disrupt the blood supply, become more progressive and result in eventual collapse of the articular surface.

Early signs on plain radiographs may include reduced bone density and the 'crescent sign' of subchondral lucency, with later radiographs demonstrating more conspicuous collapse of the bony cortex.

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Case Information

rID: 47736
Case created: 31st Aug 2016
Last edited: 14th Oct 2016
Inclusion in quiz mode: Included

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