600 - A Case of Insidious Hip Pain in a 26-Year-Old Female

We describe a case of a 26-year-old female with a relevant history of idiopathic intracranial hypertension (IIH) and intracranial encephalocele treated with surgery and high-dose steroids, presenting with 6 months of atraumatic, progressive left groin pain. Her pain improved with sitting and worsened with walking. She endorsed limping. The left anterior hip was tender to palpation. Range of motion (ROM) at the left hip was notable for 40 degrees of external rotation and 5 degrees of internal rotation with concordant pain. Right hip ROM was full. FADDIR, log roll, Stinchfield, and scour were positive at the left hip. She had an antalgic gait, with reduced single-leg stance on the left. X-ray of the left hip showed sclerosis and lucency of the left femoral head and possible superimposed subchondral fracture. MRI of the left hip demonstrated subacute articular surface collapse of the left femoral head suggestive of avascular necrosis (AVN).

 

Discussions: This is a 26-year-old female who presented with 6 months of worsening left groin pain, limited range of motion, and antalgic gait, with imaging confirming left hip AVN. The remote history of IIH and encephalocele treated with encephalocele repair and high-dose steroids likely contributed. Other causes of AVN include alcohol use, inflammatory disorders, and trauma. The patient was advised to offload the left hip with crutches, was treated with analgesics, and was urgently referred to orthopedics for surgical management.

Conclusions: In younger patients with progressive groin pain impairing activities of daily living, with pertinent risk factors in their medical history, avascular necrosis of the hip or other major joints should be considered and a part of the differential diagnosis, and imaging should be promptly ordered.