c/o pain hip , no trauma

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hip X-ray avascular necrosis femoral head atraumatic

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avascular necrosis femoral head radiographic findings staging management

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avascular necrosis femoral head Ficat Arlet staging X-ray crescent sign subchondral collapse

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atraumatic hip pain 56 year female osteoarthritis AVN differential diagnosis causes risk factors

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Radiograph Analysis — V. Aruna Kumari, 56F | Hip AP/Lateral

Key Radiographic Findings

Looking at both the AP and lateral views of the right hip (marked "R"):

Finding	Observation
Femoral head contour	Loss of normal spherical shape; flattening of the superior weight-bearing surface
Subchondral region	Increased sclerosis with areas of mixed lucency — suggestive of crescent sign (subchondral fracture)
Joint space	Relatively preserved at this stage
Femoral neck	Intact, no fracture line
Acetabulum	No significant degenerative change
Bone density	Patchy sclerosis in the femoral head consistent with ischemic necrosis

Primary Diagnosis

Avascular Necrosis (AVN) / Osteonecrosis of the Femoral Head — Right Hip Ficat & Arlet Stage II–III (sclerosis + early subchondral collapse without significant joint space loss)

Staging (Ficat & Arlet)

Stage	X-ray Finding	This Patient
I	Normal X-ray	No
II	Sclerosis/cysts, preserved head shape	Borderline
III	Crescent sign, subchondral collapse, head flattening	Likely
IV	Joint space narrowing, acetabular involvement	Not yet

Etiology to Investigate (No Trauma)

In a 56-year-old female with no trauma, consider:

Corticosteroid use (most common secondary cause)
Alcohol use
Systemic lupus erythematosus (SLE)
Hypothyroidism / dyslipidemia
Sickle cell disease
Gaucher's disease
Idiopathic (primary AVN)

Per Bailey & Love's 28th Edition (p. 572): "AVN can be primary (idiopathic) or secondary to other pathology" — interruption of blood supply leads to bone death, femoral head collapse, and eventual secondary OA.

Recommended Next Steps

Investigations:

MRI both hips — gold standard; detects early AVN, assesses extent of necrosis, checks contralateral hip (bilateral in ~50–80%)
CBC, ESR, CRP, ANA, lipid profile, HbA1c
History: steroid use, alcohol intake, autoimmune disease

Management based on stage:

Stage I–II (pre-collapse): Core decompression ± bone grafting; bisphosphonates (adjunct); protected weight-bearing
Stage III (early collapse): Core decompression with structural bone graft, or consider rotational osteotomy
Stage IV: Total Hip Arthroplasty (THA)

Reference Image (AVN Femoral Head — Bilateral for comparison)

Bilateral AVN: right side showing Stage III (sclerosis, fragmentation, head collapse); left side Stage II changes. Compare with patient's right hip findings.

Bottom line: This is right hip AVN, approximately Ficat Stage II-III, presenting as atraumatic hip pain in a 56-year-old female. MRI is urgently indicated to confirm staging, assess viability, and screen the contralateral hip before irreversible collapse occurs.

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