What is causing this man’s hip pain, limping? – Let’s diagnose

A 72-year-old man presented to the doctor with complaints of hip pain and groin pain affecting his left lower extremities that gradually began over the last couple of months. The patient denied recent trauma. He had COPD and had received high-dose injections of triamcinolone as intermittent treatment over the course of his adult life. On physical exam, decreased range of motion was noticeable. The pain was affecting his gait and causing him to limp. Radiologic exam revealed serpiginous geographic sclerosis with a lucent center involving a subchondral portion of the left femoral head.

What’s the diagnosis?

  1. Femoral neck fracture
  2. Bursitis (greater trochanteric bursitis)
  3. Rheumatoid arthritis
  4. Osteonecrosis of the femoral heads

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