A patient, aged 45 years, presented with hip pain in her left side for 6 months. The pain dramatically worsened over the last month and she started walking with a cane.
She denied any injury or precipitating event. The pain appeared to be in the groin and lateral side of the leg. Treatment with rest and nonsteroidal anti-inflammatories didn’t seem to help.
An anteroposterior (AP) x-ray and coronal magnetic resonance imaging (MRI) of the left hip are shown above.
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An AP x-ray of the left hip showed subchondral collapse and subtle flattening of the femoral head. A T1 coronal MRI image of the left hip showed dark, low intensity findings in the superior lateral femoral head. These findings are consistent with osteonecrosis of the hip.
Dagan Cloutier, MPAS, PA-C, practices in a multispeciality orthopedic group in the southern New Hampshire region and is editor in chief of the Journal of Orthopedics for Physician Assistants (JOPA).