Research Day
FEMORAL HEAD OSTEONECROSIS 3 MONTHS AFTER INTRAARTICULAR STEROID INJECTION: A CASE REPORT
Document Type
Abstract
Date
2021
Abstract
Introduction: Intra-articular corticosteroid injection (IACI) is a common treatment amongst orthopaedic surgeons, sports medicine physicians and general practitioners. IACI represents a useful tool for short term pain relief and diagnosis. However, IACI is not without complications. Amongst the rare local effects of IACI, rapidly progressive osteonecrosis bears further discussion given its antithetical effects when used for treatment of osteoarthritis. Osteonecrosis has been reported in the literature only twice after single IACI. This case report provides further evidence for osteonecrosis as an acute complication after a single IACI.
Case Description: An 86-year-old female presented to the hospital for left hip pain and a mechanical fall. On x-ray she was found to have significant bone loss to her left femoral head. On history, she had had a single x-ray guided left hip IACI 3.5months prior to presentation for left hip and knee pain as a diagnostic and therapeutic tool. She had no history of prior surgery, recent trauma (apart from the admitting fall), and no other recent steroid use or medication changes. Joint aspiration studies revealed a lack of evidence for infectious etiology. The patient was ultimately diagnosed with likely osteonecrosis due to intra-articular steroid use. Unfortunately, the patient died weeks later from a separate medical illness and never received planned hip biopsy with replacement.
Discussion: While IACI use is common practice, it is not without risks that warrant discussion with patients. This case provides further data regarding rapidity in onset as well as radiographic evidence of rapid onset osteonecrosis after IACI.