Question:
A 30 year old patient with nephrotic syndrome has been on steroids for 14 years. He has bilateral difficulty in abduction and internal rotation of the hip, and attempting to flex the hip results in abduction. What is the cause?
A 30 year old patient with nephrotic syndrome has been on steroids for 14 years. He has bilateral difficulty in abduction and internal rotation of the hip, and attempting to flex the hip results in abduction. What is the cause?
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Long-term steroids are a classic cause of femoral head osteonecrosis.
Updated On: Jul 8, 2026
- Avascular Necrosis of Femur Head
- Septic Arthritis
- Renal Osteodystrophy
- Heterotopic Calcification
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The Correct Option is A
Solution and Explanation
Step 1: Note the risk factor.
Long term, high dose steroid use is one of the leading causes of avascular necrosis (AVN), also called osteonecrosis, of the femoral head. Fourteen years of steroid therapy for nephrotic syndrome puts this patient at high risk.
Step 2: Read the clinical clues.
AVN of the femoral head classically presents with groin or hip pain and stiffness. Internal rotation and abduction are usually the first movements lost because the anterolateral part of the femoral head, the main weight bearing area, collapses first. The finding that flexion is coupled with obligatory abduction, the leg swinging outward as the patient tries to flex the hip, is a well described sign of femoral head collapse changing the joint's mechanics.
Step 3: Rule out septic arthritis.
Septic arthritis is usually acute, with fever, severe pain, warmth, and swelling of a single joint, not a chronic bilateral process developing over years of steroid use.
Step 4: Rule out renal osteodystrophy.
Renal osteodystrophy causes bone pain and deformity from disturbed calcium, phosphate, and vitamin D handling in chronic kidney disease, but it does not produce this specific hip flexion-abduction sign, and nephrotic syndrome alone does not mean the kidneys have failed.
Step 5: Rule out heterotopic calcification.
Heterotopic calcification means bone forming in soft tissue, usually after trauma, burns, or spinal cord injury, and is not linked to long term steroid use in this way.
Step 6: Final answer.
The bilateral hip findings after 14 years of steroids point to avascular necrosis of the femoral head.
\[ \boxed{\text{Avascular Necrosis of Femur Head}} \]
Long term, high dose steroid use is one of the leading causes of avascular necrosis (AVN), also called osteonecrosis, of the femoral head. Fourteen years of steroid therapy for nephrotic syndrome puts this patient at high risk.
Step 2: Read the clinical clues.
AVN of the femoral head classically presents with groin or hip pain and stiffness. Internal rotation and abduction are usually the first movements lost because the anterolateral part of the femoral head, the main weight bearing area, collapses first. The finding that flexion is coupled with obligatory abduction, the leg swinging outward as the patient tries to flex the hip, is a well described sign of femoral head collapse changing the joint's mechanics.
Step 3: Rule out septic arthritis.
Septic arthritis is usually acute, with fever, severe pain, warmth, and swelling of a single joint, not a chronic bilateral process developing over years of steroid use.
Step 4: Rule out renal osteodystrophy.
Renal osteodystrophy causes bone pain and deformity from disturbed calcium, phosphate, and vitamin D handling in chronic kidney disease, but it does not produce this specific hip flexion-abduction sign, and nephrotic syndrome alone does not mean the kidneys have failed.
Step 5: Rule out heterotopic calcification.
Heterotopic calcification means bone forming in soft tissue, usually after trauma, burns, or spinal cord injury, and is not linked to long term steroid use in this way.
Step 6: Final answer.
The bilateral hip findings after 14 years of steroids point to avascular necrosis of the femoral head.
\[ \boxed{\text{Avascular Necrosis of Femur Head}} \]
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