Transient Osteoporosis of Hip in A Middle-Aged Man

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Transient Osteoporosis of Hip in A Middle-Aged Man

Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2017, Vol 1, Issue 6

Abstract

Introduction: Transient Osteoporosis of Hip is a benign, acute onset, self-limiting disorder of unknown aetiology commonly seen in middle aged men and pregnant females. Case Report: We report a case of acute onset sharp pain in right hip in a physician without history of antecedent trauma. The diagnosis of Transient Osteoporosis of Right Hip was made based on clinical and MRI findings. The probable cause can be attributed to long standing working condition. There was complete resolution of symptoms by conservative treatment in the form of analgesics and non-weight bearing. Conclusion: High level of suspicion should be kept in mind when dealing with patients with sudden onset non-traumatic joint pain to avoid unnecessary investigations and surgeries. Transient Osteoporosis of Hip (TOH) is an acute, idiopathic, benign, self-limiting entity, more commonly seen in middle-aged men and women in third trimester of pregnancy or immediate post-partum period [1-4]. This disorder of unknown aetiology has a sudden onset, usually without any antecedent history of trauma or injury. We hereby report a case of Transient osteoporosis of hip affecting a middle aged male physician. Case Report A 38 year old physician reported with sudden onset pain in right hip joint since 2 weeks. The pain was severe sharp sudden in onset, increased with activities like walking, standing for longer duration, getting up from bed and relieved completely on rest. Being a physician himself, he first neglected the pain and went to a physiotherapist to try local modalities with limited relief. There was no history to trauma/injury to right hip, no history of morning stiffness, anorexia, fever, weight loss, night cries, skin rashes or fever. There was no history of alcohol consumption or smoking. On examination, the patient was walking with an antalgic gait. The local temperature and the skin condition over right hip were normal. The affected hip had generalized tenderness with terminal restriction of movements. His haematological investigations revealed a haemoglobin of 12.3gm%, Total leukocyte count of 5800/mm3, ESR of 32mm at the end of one hour, all of which were within normal limits. Initial radiographs in form of Pelvis with both hips Antero posterior view and frog leg lateral view revealed no bony abnormality with maintained joint space. His synovial aspiration was normal in appearance and was negative for acid fast bacilli, gram staining and was sterile with no growth on culture and sensitivity. With no conclusive diagnosis, MRI of right hip joint was done which showed low intensity signals of T1 weighted image and a high intensity on T2 weighted image covering the femoral head, neck and extending to the intertrochanteric region (Figure 1). Thus, with the aforementioned classical features, a diagnosis of Transient Osteoporosis of right Hip was made. The conservative treatment was started in the form of non-steroidal inflammatory drugs was started. The patient responded drastically to the conservative treatment within 3 weeks from the initiation of treatment. Regular monthly follow-up till 6 months followed by bi annual and annual follow-up till 2 years was done. The patient showed no signs of recurrence or worsening of the symptoms and was completely normal (Figure 2).

Authors and Affiliations

Gaurav Sharma, Akshay Bhardwaj, Nisha Relwani, Shubhangi Dubey

Keywords

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EP ID EP572852
DOI 10.26717/BJSTR.2017.01.000489
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