title: Bilateral Osteonecrosis of the Femoral Head During Pregnancy Following Two Corticosteroid Injections: A Case Report and Review of the Literature.
abstract: Osteonecrosis of the femoral head during pregnancy, or shortly thereafter, is a rare clinical problem. Little is known about pregnancy as an etiological factor for femoral head osteonecrosis with only 40 reported cases in the literature. Furthermore, single or dual dose steroid-induced multifocal osteonecrosis is a controversial topic with only a handful of published cases. We present a case of a 34-year-old female with bilateral femoral head osteonecrosis that developed during the peripartum period. She received two large intramuscular injections of steroids for fetal lung maturity because early delivery was required as a result of eclampsia. She underwent total arthroplasty of the left hip due to unremitting pain and functional disability, which achieved good clinical results--relieving her pain and improving her range of motion. Literature is scarce with regard to single or dual dose steroid-induced osteonecrosis of the hip as well as pregnancy as a general etiologic factor. This case highlights the need for high clinical suspicion of osteonecrosis as a cause of postpartum hip pain.
authors.affiliation: Division of Orthopaedic Surgery, McMaster University.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Wood
authors.affiliation: Department of Orthopaedic Surgery, Stanford University.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Hoppe
authors.affiliation: Division of Orthopaedic Surgery, Juravinski Hospital, McMaster University.
authors.forename: Mitchell
authors.initials: M
authors.lastname: Winemaker
authors.affiliation: Division of Orthopaedic Surgery, St. Joseph's Hospital, McMaster University.
authors.forename: Anthony
authors.initials: A
authors.lastname: Adili
keywords: avascular necrosis; femoral head; osteonecrosis; pregnancy; steroids