Prashanth Kumar1, Suresh Korhalli2, Suryakanth Kalluraya3, Mallesh M4
CLINICAL DETAILS: History: A 36 year old patient with bilateral hip pain and limp of nine months gradually progressed to rest pain with inability to squat and low back pain.
EXAMINATION: Bilateral hip joint line tenderness (left>right). Left hip restriction of movements, wasting with abduction deformity.
INVESTIGATIONS: X-ray showed increased density (left>right) in subchondral region of head, >50% segmental collapse in left hip, regional osteoporosis. Blood investigations showed high triglyceride, uric acid with anaemia.
MANAGEMENT: Traction and physiotherapy with Zolendronic acid 5mg i.v. infusion, balanced diet, calcium, iron and methylcobalamine supplementation.
RESULTS: X-rays revealed improvement in osteoporosis and disappearance of acetabular osreophyte, rebuilding of vertical trabaculae. MRI on 14th month showed revascularization of trabaculae with maintenance of articular cartilage without hyper intensity in T2 images. Triglycerides and uric acid level normalized.
DISCUSSION: AVN Hip is the result of vascular insult due to many causes. In this patient contributing factors are non-vegetarian diet, tobacco chewing, hypertriglyceridemia, hyperurecimia. All these resulted in endothelial damage of vessels.
CONCLUSION: AVN of femoral head grade 2 and 3 managed conservatively with physiotherapy, dietary modification and bisphosphonates gave good results as assessed with Harris hip score
