Endgames Case Review

Chronic hip pain

BMJ 2018; 360 doi: https://doi.org/10.1136/bmj.j5882 (Published 19 January 2018) Cite this as: BMJ 2018;360:j5882
  1. Heather White, medical student1,
  2. Michael Barrett, trauma and orthopaedics specialist trainee2,
  3. Christopher Gooding, trauma and orthopaedics consultant2
  1. 1University of Cambridge, Cambridge, UK
  2. 2Cambridge University Hospitals NHS Trust, Addenbrooke’s Hospital, Cambridge, UK
  1. Correspondence to H White htw28{at}cam.ac.uk

A 55 year old woman presented to her general practitioner with a six month history of pain over the lateral aspect of her left hip in the trochanteric region. She described the pain as “a niggling pain that seems to be progressively getting worse.” The pain was exacerbated on weight bearing and by activity, but did not prevent her from being active. The pain woke her at night. She had a medical history of gastro-oesophageal reflux disease, essential hypertension, and early stage breast cancer. Her breast cancer was diagnosed and treated eight years ago, and she had since been discharged from follow-up. Her only regular medication was omeprazole. She lived at home with her husband and worked as a teaching assistant. On examination, she had a marked antalgic gait. She had a good range of pain-free movement but had discomfort over the lateral aspect of the left hip during the extremes of rotation. A radiograph of the pelvis was performed (fig 1).

Fig 1

Radiograph of the pelvis (anteroposterior view)

Questions

  • 1. What are the differential diagnoses?

  • 2. What investigations would you perform?

  • 3. How would you manage this condition?

Answers

1. What are the differential diagnoses?

Short answer

Secondary malignancy, primary bone malignancy, such as multiple myeloma, osteomyelitis, benign neoplasm such as giant cell tumour, brown tumour.

Discussion

The pelvic radiograph showed at least two lytic lesions in the left proximal femur and greater trochanter. Secondary bone malignancy is the most …

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