Avascular necrosis of the femoral head with unusual symptoms: a case report
Author: Nadina Liana Pop1,2
1 Department of Physiology, “Iuliu Hatieganu” University of Medicine and Pharmacy Cluj-Napoca, Romania
2 “Dr. Constantin Papilian” Clinical Military Emergency Hospital, Cluj-Napoca, Romania
Background. Avascular necrosis of the hip (AVNH) is a debilitating osteoarticular disease that has variable risk factors, but not a very specific pathogenetic pathway. Many management options were proposed and studied for AVNH treatment, but with limited or inconsistent results, as there is not a current treatment guideline. The specific symptoms of AVNH are pain and reduced range of motion of the hip, usually painful rotations of the hip and sometimes an affected walk. In some cases, patients can present with non-specific or atypical symptoms, which can make the diagnostic difficult. The golden standard imaging for AVNH diagnostic is magnetic resonance, but simple radiography can be sufficient in many cases.
Case presentation. We report a case of a 62 years old male, without significant personal pathological history or alcohol or other substances abuse, with no chronic treatment, with a confirmed arthritis of both knees. The patient presented with mechanical pain of the left shoulder and both knees, with no present or past symptoms of the hips. The patient was evaluated by a rehabilitation medicine specialist and a painful and limited range of motion of the left hip was found. Blood works and radiological investigations were done, which confirmed the diagnostic of an avascular necrosis of the left hip, arthritis of both hips and left shoulder.
Conclusions. This case, of a generally healthy male, with no toxic behavior and no symptoms at the hip region, but with clear signs of an affected left hip at clinical examination is a particular one by correlation with an atypical presentation of an avascular left hip necrosis, which emphasizes the crucial importance of a detailed and complete physical examination of a patient, even in the case of poor or none symptomatology.
Keywords: hip pain, avascular necrosis, atypical symptoms, risk factors.