title: A prospective cohort study of the clinical presentation of non-traumatic osteonecrosis of the femoral head: spine and knee symptoms as clinical presentation of hip osteonecrosis.
abstract: To study the clinical presentation of femoral head osteonecrosis (ONFH). Publications dedicated to this aspect of ONFH are rare. Our aim was to systematically collect and describe the clinical data.
  
  
  
  A prospective survey was conducted in a cohort of ONFH recruited from a dedicated clinic for osteonecrosis. The history of symptoms, medical management, and physical findings were obtained from 88 patients suffering from 125 ONFH. Subgroups were formed: bilateral versus unilateral ONFH, radiological stages 1-2 (pre-fractured) versus fractured stage 3 versus stage 4.
  
  
  
  ONFH was bilateral in 63 %, especially in corticosteroid users and in sickle-cell cases. These patients were younger but had similar BMIs compared to the unilateral cases. The pain was mechanical in 79 % of hips and inflammatory in 21 %. Acute pain at the onset was present in 55 % of hips. The localization of this pain was variable, including in the groin, the buttocks, or diffused in the lower limbs. A limp was present in 50 % of the patients, only when one hip was painful. The physical examination of the hip was normal in 31 %, especially in stages 1-2 (55 %). The diagnosis delay was 12 months, with inadequate medical management in 51 % of patients.
  
  
  
  In ONFH cases, no typical clinical pattern was found. The clinical presentation was very variable, sometimes having spine or knee symptoms with a normal physical examination of the hip. ONFH should be systematically suspected in cases of onset of pain in the pelvis, buttocks, groin, and lower limbs.
authors.affiliation: Department of Rheumatology, CHU Sart Tilman, B35, University of Liège, 4000, Liège, Belgium. jean-philippe@hauzeur.org.
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Hauzeur
authors.affiliation: Department of Rheumatology, CHU Sart Tilman, B35, University of Liège, 4000, Liège, Belgium.
authors.forename: Michel
authors.initials: M
authors.lastname: Malaise
authors.affiliation: Department of Biostatistics and Medical Informatics SBIM & IRIBHM, School of Medicine, Université Libre de Bruxelles, Brussels, Belgium.
authors.forename: Viviane
authors.initials: V
authors.lastname: de Maertelaer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000379:methods; D015331:Cohort Studies; D005260:Female; D005270:Femur Head / Q000473:pathology* / Q000601:surgery; D005271:Femur Head Necrosis / Q000175:diagnosis* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
keywords: Clinical feature; Diagnosis; Femoral head; Hip; Osteonecrosis; Symptoms