AMA Radiology

80 year old unable to walk due to right hip pain

Radiograph of the pelvis in a adult patient. Bilateral hip prosthesis demonstrated.  Satisfactory position of the left prosthesis.  Right hip prosthesis appears to be dislocated.  There is evidence of a localised fracture with adjacent permeative change involving the acetabulum.  Appearance on imaging is suggestive of a pathological fracture.  This could represent a primary localised neoplasm such as a plasmacytoma or metastases.  I would urgently conveyed the findings to the referring physician and suggest the patient mobilise with a chair.  I would also suggest an urgent MRI scan of the pelvis as well as a staging CT examination and urgent orthopaedic referral.