case_images: PMC11823863_01
case_images: Anteroposterior radiograph of the pelvis: Reduction of bilateral hip joint space, and changes suggestive of advanced osteonecrosis of the femoral head with arthritis are noted.
case_images: JOCR-15-65-g001.jpg
case_images: PMC11823863_01_JOCR-15-65-g001.jpg
case_images: F1
case_images: Radiographs revealed symmetric reduction of the hip joint space bilaterally, with cystic changes in the femoral heads (Fig. 1).
case_images: Coronal Short Tau Inversion Recovery image on magnetic resonance imaging pelvis: Multiple regions of altered marrow signal intensity are noted, involving both acetabula, and femoral heads and necks. Mild fluid collection is noted in both hips.
case_images: JOCR-15-65-g002.jpg
case_images: PMC11823863_01_JOCR-15-65-g002.jpg
case_images: F2
case_images: Magnetic resonance imaging revealed changes suggestive of avascular necrosis (Fig. 2).
case_images: 18F fluoride positron emission tomography/computed tomography image of the pelvis: Photopenic areas are noted in both femoral heads, with surrounding margins of increased tracer uptake. Intense uptake is also noted in both acetabula.
case_images: JOCR-15-65-g003.jpg
case_images: PMC11823863_01_JOCR-15-65-g003.jpg
case_images: F3
case_images: Intense 18F fluoride uptake was also noted in both acetabular margins, suggesting the possibility of septic arthritis (Fig. 3).
case_images: Anteroposterior radiograph of the pelvis, following first stage surgery: Bilateral articulating cement spacers are seen in situ.
case_images: JOCR-15-65-g004.jpg
case_images: PMC11823863_01_JOCR-15-65-g004.jpg
case_images: F4
case_images: Similar intraoperative findings were noted in the right hip, and a similar procedure was performed over the right side (Fig. 4).
case_images: Radiographs of the patient at the latest follow-up. (A) anteroposterior radiograph of pelvis. (B and C) lateral radiographs of the right and left hips, respectively.
case_images: JOCR-15-65-g005.jpg
case_images: PMC11823863_01_JOCR-15-65-g005.jpg
case_images: F5
case_images: At 3 years' follow-up, the patient was found to be doing well, with a Harris Hip Score of 93 points, and no limb length discrepancy (Fig. 5).