Visual Diagnosis in Emergency Medicine| Volume 57, ISSUE 4, e123-e124, October 2019

Rapidly Destructive Osteoarthritis: The Case of the Missing Femoral Head

      An 80-year-old woman presented to the Emergency Department (ED) complaining of atraumatic hip pain and difficulty ambulating. The patient had longstanding pain issues; x-ray studies performed 6 weeks prior to her ED visit demonstrated circumferential joint space narrowing (Figure 1). She had received an intraarticular hip injection of triamcinolone 5 weeks prior, to temporize for total hip arthroplasty, but developed worsening pain after brief improvement in symptoms. On examination she was afebrile, with pain on range of motion of her left hip, but normal strength, sensation, and distal pulses. Laboratory evaluation was negative for leukocytosis; c-reactive protein was not elevated.
      Figure thumbnail gr1
      Figure 1Anteroposterior pelvis and lateral x-ray studies of the left hip 1 week prior to steroid injection (6 weeks prior to emergency department visit).
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