Total hip arthroplasty for diffuse skeletal fluorosis

A woman in her late 50s with a history of multiple prior orthopaedic surgeries presented with severe left hip pain. Initial pelvic radiographs showed diffuse sclerosis, cortical thickening and coarse trabeculae, suggesting polyostotic Paget's disease or another metabolic disorder. However, further imaging revealed widespread skeletal sclerosis and cortical thickening throughout the axial skeleton. In addition, a history of chronic inhalant abuse was reported in the medical record. In conjunction with the patient's history of computer duster abuse and potential difluoroethane exposure, a subsequent diagnosis of diffuse skeletal fluorosis was made. Subsequently, the patient underwent a left total hip arthroplasty, and pathological examination of the resected femoral head revealed enlarged, irregular trabeculae and high osteoclastic activity, compatible with osteosclerotic bone disease. This case highlights the diagnostic challenges of complex medical histories, particularly when patients may not be forthcoming about inhalant abuse and underscores the importance of comprehensive evaluation and long-term monitoring.