Hip pain

A 42-year-old male sustained AVN of his right hip after low total dose corticosteroid treatment. This patient presented to our department with worsening of his right hip pain, which had been present for four years. There was no history of trauma. The patient had sustained a lower back injury three years before, and his worsening hip pain had previously been attributed to this. His past medical history was significant for an umbilical hernia and asthma controlled with an albuterol inhaler as required; it was negative for any history of autoimmune disease. Family history was significant for hypertension in both parents and negative for autoimmune diseases. He had a 15 pack-year smoking history and no history of alcohol abuse. Upon further investigation, it was found that he had been treated for a chronic bronchitis exacerbation four years before.

Examination

Physical exam revealed a reduced range of passive and active motion of the right hip. Bilateral plain films and magnetic resonance imaging of the hips were obtained due to concern of AVN. The final impression of the magnetic resonance imaging was read as bilateral AVN of the hip, with the right hip having had a more acute phase with marrow involvement than the left.