Hip Pain with Prior Cephalomedullary Nail in 82F

HPI

This 82-year-old retired accountant presents with left hip pain and stiffness 2 years following cephalomedullary nail stabilization of a left intertrochanteric hip fracture. The pain is severe enough that it limits many of her daily activities and she walks with a significant limp and is cane dependent. She attempted conservative treatments including physical therapy to try increase her hip motion, and nonsteroidal anti-inflammatories, but neither of these led to significant improvement in her symptoms. A metal suppression MRI was performed (not shown) that showed osteonecrosis that encompassed the vast majority of her femoral head with evidence of femoral head collapse.

PMH

Unremarkable

PE

On physical exam she has a 15 degree hip flexion contracture and 10 degree external rotation contracture in that left leg. Absolute external rotation is around 20 degrees. She has percutaneous small incisions located relatively posteriorly that are well healed with no erythema or other signs of infection. She has normal femoral and sciatic nerve root function and normal dorsalis and posterior tibial pulses. She had no significant hip abductor weakness and no Trendelenburg sign.