The stubborn hip: idiopathic avascular necrosis of the hip

Abstract

Objective: To highlight the unusually indolent course of avascular necrosis in this patient, the risk factors of which chiropractors should be aware, the necessity of and means to an early diagnosis, the limitations of plain film radiographs, as well as the current medical treatments.

Clinical features: A 27-year-old male professional soccer player had a tight and achy right hip for approximately 6 years, a condition that increased with physical activity. His active range of motion was limited by 25% in extension and abduction, and all resisted ranges of motion produced pain. After an equivocal radiograph and bone scan, magnetic resonance imaging revealed a subchondral defect located on the superior aspect of the right femoral head, consistent with avascular necrosis of the femoral head.

Intervention and outcome: Presurgical management included Cybex testing, massage, myofascial release, interferential current, muscle strengthening, and muscle balancing exercises 3-5 times per week for 5 months. The patient underwent a curette procedure. Six weeks later, he returned to the chiropractic office for postsurgical rehabilitation, in which he is still involved today. He has made progress with respect to flexibility, strength, and muscle coordination.

Conclusions: Idiopathic avascular necrosis of the hip is a clinical entity characterized by pain in the hip made worse with activity and at night, which may radiate to the groin, back, or thigh. Often, physical exam and radiographic findings are equivocal, at which point advanced imaging such as magnetic resonance imaging should be ordered to identify the disease in its earliest stages.