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

Performed

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

Hb: 12.2 g/dL
Hct: 37%

Platelets : 230,000/mm3
ESR + CRP

Performed

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

Performed

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

Performed

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
Steroids
IV Antibiotics
Femoral Osteotomy
Total Hip Replacement