A 36-year-old woman with sickle cell disease presents with increasing pain in her right hip. She has no fever, chills, back or other bone pain, and there is no history of any trauma.On examination, her temperature is 37.3degC, range of motion in the right hip is reduced, she walks with a limp, and the right leg is shorter than the left. Movements of the hip and walking on it are painful. X-rays of the hip are shown in Figure below. Which of the following is the most likely diagnosis?
High-Yield Explanation
The diagnosis is AVN of the femoral head. Bone complications occur frequently in patients with sickle cell anemia. Infarcted areas of bone and bone marrow can become sites of infection (osteomyelitis) with Staphylococcus aureus or salmonella, but the lack of fever and clinical signs in this patient suggest AVN. Infarction of the femoral head nutrient artery leads to AVN and chronic joint pain. The humeral head is also at risk of AVN. Septic arthritis is a less common complication.