| Answer: Osteonecrosis of the femoral head. |
| Discussion |
Alcohol abuse and systemic corticosteroid therapy are the major associated risk factors for osteonecrosis. Other associated risk factors are listed in Table 1.
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| Table 1. Clinical Conditions Associated with Osteonecrosis |
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| Corticosteroid Use | Gaucher disease |
| For systemic lupus erythematosus | Myeloproliferative disorders |
| For rheumatoid arthritis | Coagulation deficiencies |
| For renal transplantation | Trauma |
| For asthma | Chronic pancreatitis |
| Alcohol abuse | Caisson disease |
| Sickle-cell and other anemias | Radiation |
For larger view click on image
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Fig. 1-a |
Fig. 1-b
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| Approximately 10% to 20% of patients who present with osteonecrosis have no identifiable diagnosis1,2. Figure 1-a is a plain radiograph of the right hip joint, showing the sclerotic and cystic changes as well as the collapse of the femoral head that are characteristic of osteonecrosis. Plain radiographs remain the first imaging choice for the investigation of osteonecrosis. Because plain radiographs alone are often inadequate for evaluating the extent of osteonecrosis of the hip, the next diagnostic procedure to perform is magnetic resonance imaging (MRI). MRI has a sensitivity and specificity of >99%, and provides confirmation of a diagnosis of osteonecrosis. On T1-weighted images, the earliest finding of osteonecrosis is a single density line that represents the separation of normal and ischemic bone. On T2-weighted images, within this line a second, high-signal-intensity line that is believed to represent hypervascular granulation tissue can be seen; this is called the "double-line sign"1 (Fig. 1-b). MRI is also most helpful for investigation of suspected osteonecrosis in hips with normal plain radiographs and for evaluation of the contralateral hip for a possible diagnosis of osteonecrosis. |
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After evaluating this patient's radiograph and MRI, what would be an appropriate treatment plan?
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