NSAID induced avascular necrosis and arthropathy of femoral head

The authors present the case of an 81-year-old woman with pain in her left hip. X-ray showed moderate osteoarthritic changes. The patient was prescribed diclofenal sodium (Voltaren), a nonsteroidal anti-inflammatory drug (NSAID). The patient continued use of the drug and returned 18 months later complaining of severe hip pain and difficulty in walking. X-ray, at that time, showed necrosis of the femoral head with subluxation and formation of a pseudoacetabulum. Total hip replacement was performed and the patient resumed normal daily activity. The authors point out that avascular necrosis of the femoral head, a known complication of steroid therapy, can also be caused by NSAID therapy and urge physicians to be aware of this complication.