The following pelvic x-ray is from a 85 year old female patient with long standing bilateral hip pain which is currently more worse on the right side. What can you see?

Magnified view:-

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The pelvic x-ray shows abnormal sclerosis of bilateral femoral heads. There is also a subchondral fracture of the right femoral head. The overall appearance is suggestive of bilateral avascular necrosis.

There is an interesting mnemonic for causes of avascular necrosis, which I got off the internet – VINDICATE:

Vascular – sickle cell anaemia

Infection – septic emboli/ Idiopathic

Drugs/toxins – steroids, alcohol

Inflammatory – pancreatitis

Congenital – Gaucher’s disease

Autoimmune – SLE, Rheumatoid

Trauma – fracture/dislocation, dysbarism, radiation

Endocrine/metabolic – Cushing’s

Our patient did not have any of the risk factors above, so the AVN is likely idiopathic..

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