More limping

A 9 year old caucasian girl presents with acute pain in her right hip for 1 day. She gives a history of chronic, progressively worsening pain in the same hip for the last 6 months. There is no history of trauma and she is otherwise asymptomatic.

Her medical history is unremarkable and she is not on any medications.

Select Relevant Investigations
Full Blood Count


WBC/DC: 7,800/mm3
Lymphocytes: 35%
Neutrophils: 62%

Hb: 12.2 g/dL
Hct: 37%

Platelets : 230,000/mm3


The ESR is 5 mm in the first hour (normal).

The C-Reactive protein level is < 6 g/l (normal).
X-Ray Pelvis and Hips


The X-ray of the right hip shows sclerosis and flattening of the right femoral head with early fragmentation. The lateral pillar height is decreased by < 50%.

The pelvis and left hip appear normal.
MRI Right Hip


The MRI shows flattening, sclerosis and early fragmentation of the right femoral head, with a small joint effusion. The double-line sign is present.

Select Relevant Management
IV Antibiotics
Femoral Osteotomy
Total Hip Replacement