Man with Right Hip pain

Thursday, February 25, 2010
This is a Xray of a right hip of a 58 years old male patient who was previously diagnosed with ulcerative colitis and was on Prednisilone treatment  now complaining of gradual onset of mild to moderate hip pain which was becomes worse when he was trying to lift some heavy objects from affected side.But his movements of the hip were not restricted in to a greater extent.


Identify this Xray?



ANSWER

AVASCULAR NECROSIS OFTHE HEAD OF THE FEMUR


Also known as osteonecrosis, aseptic necrosis, ischemic bone necrosis
Resulting from the temporary or permanent loss of the blood supply to an area of bone
Some regions of the human skeleton have a much higher tendency to develop ischaemia
  1.  neck of femur
  2.  proximal pole of the scaphoid bone
  3.  body of the talus

CAUSES

Trauma:
  • Fracture of the neck of femur
  • Complication of osteo- and rheumatoid arthritis
  • Neuropathic joint


Idiopathic:
  • Typically middle aged men
  • Affects hips and knees


Perthe's disease


Theimann's disease


High levels of steroids:
  • Iatrogenic
  • Cushing's syndrome
  • Pregnancy


Systemic disease:
  • SLE
  • Sickle cell anaemia
  • Infective endocarditis
  • Chronic liver disease
  • Pancreatitis
  • Alcoholism
  • Hyperlipidaemia
  • Hypertension
  • Caisson disease
  • Gaucher's disease
  • Diabetes mellitus
  • Polycythaemia rubra vera
  • Radiation

CLINICAL FEATURES

Primarily affects the joints at the shoulder, knee, and hip
Avascular necrosis usually affects people between 30 and 50 years of age
Onset may be insidious but often there is a dramatic onset of pain.

INVESTIGATIONS

X-ray the avascular bone appears dense (whiter)
Early stage of the disease x-ray images usually appear normal so Bone scans is useful

TREATMENT

Hip joint Avascular Necrosis is a common indication for total hip replacement in older patients


Hip resurfacing or metal on metal (MOM) resurfacing in younger patients and Realignment osteotomy


Bisphosphonates- reduces the rate of bone breakdown by osteoclasts, thus preventing collapse

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15 comments

  1. Anonymous Says:
  2. Avascular necrosis of femoral head

     
  3. Anonymous Says:
  4. steroid therapy is a 2ry cause for osteoporosis , one of the most common sites is neck of femur , so that will be the most probable Dx

     
  5. Anonymous Says:
  6. femoral head necrosis due to chronic take of prednisolone which led to arthritis

    Alexandros

     
  7. Anonymous Says:
  8. This man diagnosed as having ulcerative colitis and was on Prednisilone for sometime.The most common adverse effects of steroids are osteoporosis and avascular necrosis of the hip.This x-ray doesn't show features of osteoporosis. The pain aggrevate with weight bearing and no restricted movements.
    My diagnosis is avascular necrosis of hip

     
  9. Anonymous Says:
  10. steroid mayopathy may be the cause...

     
  11. Anonymous Says:
  12. Aseptic necrosis of the Hip from long term Steroid therapy.

     
  13. Anonymous Says:
  14. serum-negative arthritis is often seen in patients with ulcerative colitis, especially in HLA-B27 positive patients.

     
  15. Anonymous Says:
  16. osteoporosis due to steroid therapy

     
  17. shameel Says:
  18. Avascular necrosis of head of femur..

     
  19. Anonymous Says:
  20. features of arthrosis n clinical arthritis....

     
  21. dr.ain Says:
  22. avascular necrosis of femoral head due to steroid use...key: look at the flattening of head of femur,this is grade I AVN

     
  23. Anonymous Says:
  24. avascular necrosis

     
  25. Anonymous Says:
  26. osteoporosis of hip joint(femoral head)---avascular necrosis

     
  27. anm Says:
  28. Mild flattening of the femoral head is seen,, that would have been evident if a comparison with the other side was available. Drug history should also be considered and the most likely diagnosis is grade I AVN of femoral head.

    anm

     
  29. Anonymous Says:
  30. Hi,
    Could it be IBD associated peripheral arthritis?

     

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