Please Help 57F Annual Post Op follow up Right THR XRs, what do you think of the intracortical lucency at the posterolateral Rt proximal femoral shaft??

I was curious what the group thought….those who responded favored a
fracture or stress reaction, possibly related to the THR, or insufficiency.
I’m not sure if you are viewing the images on your laptop or phone…I have
the advantage of the monitor—–the surprising finding (to me) is that the
longitudinal posterolateral intracortical lucency….which is in the Right
proximal femur only, was present even before the THR, back in 2019….and
it appears unchanged.

I spoke to the orthopedist from HSS who said she is completely “pain free
with a rock solid THR” and added “thanks for calling me, but I don’t want
to get any additional imaging or do anything about this finding…okay?”
She has never been on bisphosphonates and is not an athlete.

Years ago I posted an unusual longitudinal intracortical fracture in an
older woman at the medial proximal femur….which I cannot find….but I
found a relevant reference
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4811848/
I had been concerned this might be an unusual fracture—–but the
published case (and my prior case) was symptomatic….and this woman is not.

She will continue to follow up with annual post THR radiographs.
So long as she is asymptomatic, I suppose we should treat the patient and
not the pictures.

Thanks to those who shared their opinions.

Hilary

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