Radiation Induced AVN of Hip Joint Following Pelvic Irradiation for Endometrial Carcinoma

AVN of the femoral head is a grave complication following pelvic irradiation. This case report provides an insight into diagnosis and management of this underestimated but important clinical problem. Due to its precarious blood supply, femoral head is one of the most common sites to undergo osteonecrosis following irradiation. A dose of 50 Gy has been accepted by various authors as threshold for development of radiotherapy induced AVN of femoral head.

This is a case report of a 72 years old housewife who presented with localised pain in the right hip and groin for the last 2 months with no history of previous trauma or osteoarthritis right hip. On examination of right hip, patient had painful range of motion with 2cm of true shortening and 10 degree of fixed flexion deformity. In past Two years back, she was diagnosed as a case of adenocarcinoma of endometrium. She was treated by three cycles of chemotherapy followed by Abdominal Hysterectomy with Bilateral Salpingo-Opherectomy. Post operative she received adjuvant external beam radiotherapy and three sessions of intravaginal high dose rate (HDR)brachytherapy. She remained alright for two years following radiotherapy course. She presented to us with pain and limping right hip for last two months. Patient was subjected to detailed investigations like MRI, CT scan, Roentgenographic Evaluation and CT Guided Biopsy and was diagnosed as case of post irradiation AVN of right hip (STAGE IV). After having excluded the presence of metastases in the right hip, patient was taken up for cemented Total Hip Replacement with bone grafting of the medial deficient acetabular wall. Patient was discharged on 7^th post OP day with full restoration of limb length and painless fully mobile hip without limping.

Post irradiation AVN of the hip joint remains a diagnostic dilemma for the clinicians and if not managed timely and adequately it leads to severe morbidity in the patients. A high index of suspicion and cautious exclusion of progression of skeletal metastases is the key in timely diagnosis of this otherwise rare but grave long term complication following pelvic irradiation.