Disclosures: Alyssa Goldenhart, BS: No financial relationships or conflicts of interest

Case Diagnosis: A 66-year-old patient with stage-III avascular necrosis of the right hip was able to decrease the necrosis to stage-II and to completely eliminate his pain through total weight elimination of the right hip.

Case Description: Patient presented for complaints of severe right hip pain. On examination, the patient had limited range of motion, pain with movement, and an antalgic steppage gait. He was prescribed Voltaren gel, a steroid pack, and was given a script for an X-ray. The film revealed sclerosis and lucency in a portion of his right femoral head, concerning for avascular necrosis. An MRI revealed stage-III avascular necrosis. Urgent referral for Orthopedic surgery was added. The specialist’s recommendation was to stay non-weight bearing on his hip for 6 weeks using a walker when necessary, avoid medications, except for his daily aspirin for anti-inflammatory effects, and omit alcoholic intake. After two months, he returned with a complete improvement of hip pain. We recommended continuing to use the crutches and staying non-weight bearing. For exercise, we recommended cycling or water aerobics.

Discussion: The recognition and appropriate follow-up of avascular necrosis are paramount for outpatient management. Treatment for avascular necrosis at stages III and IV typically involves either core decompression or total hip arthroplasty. However, our case uniquely demonstrates that with strict conservative management, surgery for the later stages of avascular necrosis may not be necessary.

Setting: Outpatient Primary Care ClinicAssessment/

Results: After six weeks of no weight bearing on his right hip, the patient eliminated all of the pain in the joint. He was walking without a walker or crutches and only taking a daily aspirin. Notably, we also witnessed a dramatic improvement in his antalgic gait.

Conclusion: Rigid conservative management for stage-III avascular necrosis may prevent the need for invasive surgical procedures.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/avascular-necrosis-a-case-report/