Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with a chronic, progressive limp and activity-related left hip pain. Pain is described as dull, aching, and localized to the groin/thigh, occasionally radiating to the knee. No history of acute trauma. Symptoms exacerbated by weight-bearing and physical activity, with partial relief upon rest. No systemic symptoms, fever, or weight loss reported.
Clinical Examination Findings
Left hip examination reveals restricted range of motion, specifically limited abduction and internal rotation. Positive Trendelenburg sign noted on the left. Mild atrophy of the left thigh musculature observed compared to the contralateral side. Gait analysis demonstrates an antalgic gait pattern favoring the right lower extremity. No erythema, warmth, or fluctuance noted over the hip joint.
Treatment Protocol
Management plan includes activity modification, avoidance of high-impact sports, and physical therapy to maintain hip range of motion. Use of crutches or orthotic bracing may be indicated to offload the femoral head. Serial radiographic monitoring (AP and frog-leg lateral views) scheduled to assess progression through stages of necrosis, fragmentation, and reossification. Surgical consultation for containment procedures (e.g., osteotomy) if significant deformity or subluxation is identified.