title: Bilateral idiopathic osteonecrosis of the femoral head: a case report with an emphasis on differential diagnosis, imaging, and treatment.
abstract: OBJECTIVE
  The purpose of this case report is to describe a patient with bilateral idiopathic osteonecrosis of the femoral head (ONFH), provide a discussion of differential diagnosis for anterior hip pain, imaging, and treatment recommendations for ONFH.
  
  
  METHODS
  A 34-year-old man was initially treated by a chiropractic physician for low back pain. At the end of a three week trial of care, the patient's low back pain resolved. However, he reported a new complaint of mild left anterior hip stiffness. After re-examination, a homecare exercise program was prescribed. The patient returned 1 month later with substantial left anterior hip pain and walked with a noticeable limp. Radiography of the left hip demonstrated advanced ONFH. Magnetic resonance imaging of both hips demonstrated the extent of involvement of the left hip while incidentally revealing ONFH on the right.
  
  
  RESULTS
  A total hip arthroplasty was performed on the left hip and the right hip is being monitored without intervention.
  
  
  CONCLUSIONS
  Osteonecrosis of the femoral head is a challenging clinical problem with non-specific and wide-ranging signs and symptoms requiring clinicians to engage a cautious and comprehensive differential diagnosis. Prompt recognition ensures that appropriate treatment can be initiated in a timely manner and optimal patient outcomes achieved.
authors.affiliation: Diagnostic Imaging Resident, Department of Radiology, Logan University, Chesterfield, MO.
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Battaglia
authors.affiliation: Chiropractor, Private Practice, Chandler, AZ.
authors.forename: Jordan
authors.initials: J
authors.lastname: Gliedt
authors.affiliation: Physician Assistant, Private Practice, Chandler, AZ.
authors.forename: Courtney
authors.initials: C
authors.lastname: McDaniel
authors.affiliation: Chair, Department of Radiology, Logan University, Chesterfield, MO.
authors.forename: Norman
authors.initials: N
authors.lastname: Kettner
keywords: Avascular necrosis of femur head; Chiropractic; Diagnosis, differential; Imaging, magnetic resonance; Osteonecrosis