46-year-old male with severe left hip pain. Evaluate for severity of avascular necrosis or signs of osteoporosis or infection. There is advanced osteonecrosis of the femoral head with collapse and fragmentation as seen on recent radiographs. There is also severe osteoarthritis of the hip with full-thickness cartilage loss superiorly. There is a small amount of fluid within the joint along with synovial enhancement which is nonspecific and could certainly be secondary to the patient's severe avascular necrosis and osteoarthritis, although it is impossible to exclude septic arthritis. Similarly, there is abnormal edema type signal abnormality within the neck and intertrochanteric region of the proximal femur as well as within the acetabulum that is nonspecific and could represent bone ischemia, reactive changes due to severe degenerative osteoarthritis or osteomyelitis. There is mild to moderate edema and enhancement of the musculature of the hip. The large field-of-view sequence of the pelvis shows less advanced osteonecrosis of the right femoral head. There is residual red marrow within the bones of the pelvis and proximal right femur. The sacroiliac joints are within normal limits. The pubic symphysis is within normal limits.
Advanced avascular necrosis and osteonecrosis of the left hip. A small amount of fluid within the joint with enhancement of the synovium, surrounding soft tissues, and adjacent bone marrow may simply be due to the patient's underlying severe avascular necrosis and osteoarthritis, however, we cannot exclude the possibility of a septic joint.