Differential Diagnosis for Severe Left Hip Pain in an 80-Year-Old Female
Single Most Likely Diagnosis
- Osteonecrosis of the femoral head: This condition is common in elderly females, especially those with a history of osteoporosis or steroid use. The sudden onset of severe hip pain without trauma is a classic presentation, as the bone tissue dies due to lack of blood supply.
Other Likely Diagnoses
- Osteoporotic fracture: Given the patient's age and the absence of trauma, a spontaneous fracture due to osteoporosis is a plausible diagnosis. These fractures can occur with minimal or no trauma in elderly individuals with weakened bones.
- Degenerative joint disease (osteoarthritis): While osteoarthritis typically presents with gradual onset of pain, an acute exacerbation could lead to severe pain, especially if there's a sudden increase in inflammation or a bone spur causing irritation.
- Bursitis or tendinitis: Inflammation of the bursae or tendons around the hip can cause severe pain, especially if it occurs suddenly. This could be due to overuse or an inflammatory condition.
Do Not Miss Diagnoses
- Septic arthritis: Although less common, septic arthritis is a medical emergency that requires prompt diagnosis and treatment. The risk is higher in elderly patients, and the presentation can be subtle, with pain being the primary symptom.
- Hip fracture (stress or insufficiency fracture): These fractures can occur without significant trauma in osteoporotic bones and may present with sudden onset of pain.
- Avascular necrosis due to other causes (e.g., sickle cell disease, chronic steroid use): While less common, these conditions can lead to avascular necrosis and should be considered, especially if the patient has a relevant medical history.
Rare Diagnoses
- Bone tumors (primary or metastatic): Although rare, bone tumors can cause sudden onset of severe hip pain, especially if they lead to a pathological fracture.
- Inflammatory arthropathies (e.g., rheumatoid arthritis, lupus): These conditions can cause hip pain but are less common in presenting with sudden, severe pain in an elderly patient without a known history of the disease.
- Infection of the bone (osteomyelitis): This is a rare but serious condition that could present with severe hip pain and should be considered, especially if there are signs of infection or a history of recent infection.