Progressive avascular necrosis (AVN) of the femoral heads over time in a patient with sickle cell disease

Plain radiographs show changes in the femoral heads and pelvis in a single patient over time.

Panel A shows a step-off of the articular surface on the R.
Panel B shows bilateral changes 3 months later, with irregular contours, flattening of both femoral heads, and abnormal sclerosis and lucency.
Panel C shows further progression after an additional 6 months, with further flattening of the L femoral head, joint space narrowing in both hips, and patchy lytic and sclerotic regions in both femoral heads.

AVN: avascular necrosis; R: right; L: left.

Courtesy of Alex George, MD, PhD.

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