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Case Report

Author(s): Bhadra A, Rahaman A, Rouf MA, Fahim MI

PAH Med Col J. Jul 2026; 3(2): 66-73

Abstract

Background: Avascular necrosis (AVN) of the femoral head is a progressive and disabling condition that predominantly affects young adults. Prolonged corticosteroid exposure is a well-established risk factor, while unsupervised steroid use remains a concern in resource-limited settings.

Case Summary:

A 19-year-old woman from a low-income rural background in Bangladesh presented with bilateral hip pain for three years and progressive difficulty walking for one year. She had taken oral corticosteroids for approximately four years on the advice of an unqualified practitioner. Examination revealed an antalgic gait, bilateral restriction of hip movements, more pronounced on the left, a positive Thomas test, and 1 cm supratrochanteric shortening of the left lower limb. Pelvic radiographs demonstrated bilateral joint-space narrowing, femoral head distortion, osteosclerosis, and marginal osteophyte formation, consistent with advanced AVN. Screening for tuberculosis and septic causes was negative. Staged uncemented modular total hip arthroplasty was performed through the direct lateral (Hardinge) approach, with the left hip replaced first and the right hip approximately ten months later following preoperative traction.

Results: At follow-up, the patient was walking comfortably with satisfactory function of both hip replacements.

Conclusion:

Unregulated and prolonged corticosteroid use can lead to severe bilateral AVN even in very young patients. Early recognition and appropriate management are essential. Staged total hip arthroplasty can provide satisfactory functional recovery in young patients with end-stage bilateral AVN.

Keywords

Avascular necrosis, Femoral head, Corticosteroids, Total hip arthroplasty, Young adult, Case report

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How to cite: Bhadra A, Rahaman A, Rouf MA, Fahim MI. Staged Bilateral Uncemented Total Hip Arthroplasty for Steroid-Induced Avascular Necrosis of the Femoral Head in a Young Woman. PAH Med Col J. Jul 2026; 3(2): 66-73.

DOI: https://doi.org/10.70945/pahmc.v03i02.05