Presentation
Right hip pain. History of chronic corticosteroid therapy.
Patient Data
Initial x-ray
Patchy, ill-defined areas of increased density with a relatively large subchondral cyst are seen in the right femoral head. Additionally, a thin lucent crescent sign is noted in the lateral aspect of without signs of cortical collapse (stage II).
Follow-up x-ray after 6 months
Mixed osteosclerosis, with a relatively large subchondral cyst and a thin lucent crescent in the lateral aspect, is observed in the right femoral head, accompanied by a slight cortical collapse in the lateral (stage III - slight collapse).
Follow-up x-ray after 2 years
Mixed osteosclerosis, along with relative collapse, is noted in the right femoral head, accompanied by secondary degenerative changes, including subchondral sclerosis, irregularity and cysts, and small marginal osteophytes in the right hip joint (stage IV - degenerative changes).
A comparison of the osteonecrosis of the right femoral head shows the eventual cortical collapse and added secondary degenerative changes.
Case Discussion
This case demonstrates a two-year x-ray follow-up of osteonecrosis of the femoral head in a 40 years old male patient with chronic corticosteroid therapy.
Several staging systems exist for osteonecrosis of the hip. The earliest and most commonly used is the Ficat and Arlet classification, which includes x-ray. It should be noted that CT is often more sensitive than plain film in showing subchondral fractures, and MRI is the most sensitive modality for early-stage and subtle changes.
Unable to process the form. Check for errors and try again.