Bilateral Osteonecrosis of the Femoral Head and Proximal Femur After Corticosteroid Injections: A Case Report

Atraumatic bilateral osteonecrosis of the femoral head (ONFH) is a rare phenomenon whose etiology is not fully understood. In this report, we describe the case of a 75-year-old female patient who developed rapidly onset bilateral ONFH after intra-articular corticosteroid injections. She was treated with staged bilateral total hip arthroplasty. Several months post-operatively, she developed aseptic loosening of the left femoral implant and requiring revision of her femoral implant. The severity and distal extent of her osteonecrosis was not fully appreciated upon initial surgical management, likely increasing her risk of failure of femoral implant osseous integration. This case demonstrates that intra-articular corticosteroid injections can cause severe ONFH with extension into the proximal femur and fixation failure. Thus, the extent of osteonecrosis in the proximal femur may influence stem choice.