Bilateral femoral head avascular necrosis

Case contributed by Dr Liam Pugh


Presented with left hip pain after getting leg dragged back while riding motorcycle at 50km/hr. Past history of type 2 diabetes, cardiomyopathy and osteoarthritis.

Patient Data

Age: 38
Gender: Male

Bilateral avascular necrosis of the femoral heads.

Some collapse of the femoral heads especially on the left.

Subchondral sclerosis and a separate fragment in the right femoral head.

Case Discussion

This patient presented with a history of trauma which may have caused pain due to the underlying avascular necrosis. It is important to consider alternative reasons for symptoms and be vigilant for incidental findings.

Avascular necrosis of the hip is bilateral in 40% of non traumatic cases. It's appearance on plain film suggests that this is not early disease. It can be classified based on x-ray, MRI and clinical features using Ficat staging.

The history of diabetes may have contributed as a cause and the cardiomyopathy could also be suggestive of other underlying risk factors such as hyperlipidemia and smoking.

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