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Osteonecrosis — SCE Rheumatology MCQ

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HardMetabolic bone diseaseOsteonecrosisSCE Rheumatology

A patient with SLE and previous high-dose glucocorticoids has load-related groin pain. Radiographs are normal but unilateral MRI shows a small pre-collapse femoral-head osteonecrotic lesion. What is the best next plan?

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Correct answer: E — Bilateral hip MRI staging with early joint-preservation orthopaedic review

Explanation lettering: C = shown as A · E = shown as C · A = shown as E

A is correct. Early osteonecrosis can be occult on radiographs and bilateral, particularly after systemic glucocorticoids. MRI of both hips defines extent and stage, while early orthopaedic review allows load advice and consideration of joint-preserving strategies before collapse. B delays sensitive imaging and may worsen mechanical injury. C ignores the positive MRI diagnosis. D adds a causal exposure. E discards the therapeutic window. Lesion size and location, symptoms and underlying disease determine whether observation, core decompression or other intervention is appropriate.

Reference: Royal National Orthopaedic Hospital: avascular necrosis: https://www.rnoh.nhs.uk/patients-and-visitors/patient-information-guides/patients-guide-avascular-necrosis-avn