Possible AVN of the hips, is an MRI absolutely necessary?

[Orome]

I'm in my early 30's and recently developed bilateral hip pain that isn't going away. The only think I can think of as a cause is past prednisone use. Orthopedist did an xray which didn't show signs of AVN but mentioned that in the early stages it doesn't always show up on an xray.

I have a prescription for an MRI but I have major concerns with doing one because of another rare medical condition I have - hyperacusis. Loud noises are physically painful for me and can have lasting effects (lingering pain and increase in tinnitus). Even with earplugs I have concerns of it being too loud for me. After a hearing injury I had years ago my ears simply don't tolerate noise levels that are okay for most people.

My question is: Is it worth trying to diagnose AVN early before it can be seen on an xray? For me it's not a zero risk exam.

Are there any other exams I could do instead of the MRI that would either detect or rule out recent onset avascular necrosis?

 

[Mojo333]

@Orome
Welcome to the forum.
I am sorry you are having problems finding the cause of your pain and
I'm sorry you have a complication that makes having an MRI a major event. Hyperacusis sounds difficult to say the least.
I will tag @Josephine, our Nurse Director as she has decades of experience as an orthopedic surgical nurse and will be best qualified to answer this question.
It may be a bit but she will see your questions.

 

[Mojo333]

By the way, I found someone with a hearing issue similar to yours discussing their experience with MRI on this site's patient forum
https://community.actiononhearingloss.org.uk/
Since it will be a torso MRI, do you think earplugs plus noise reduction head set, industrial use type, could get you through it?

 

[Orome]

I have doubts that it would be enough for me. For example, a noisy restaurant is too loud for me even with earplugs. I'm just questioning if it's worth the risk to try to diagnose it (or rule it out) in the early stages. From my reading it seems like there are some things that can be attempted if you catch it very early on before you need a total hip replacement, but most of those treatments don't have the best success rate. I would like the peace of mind knowing the pain isn't caused by AVN if that isn't the case.

Hyperacusis is another one of those invisible conditions that can be debilitating. Add to that the possibility of AVN of multiple joints and that's just too much.

Are there any other exams or tests that can show AVN in stage 1? Nuclear bone scan, CT, etc.?

 

[Jaycey]

The only think I can think of as a cause is past prednisone use.

Very possible unfortunately.

Is it worth trying to diagnose AVN early

Yes because the sooner you address AVN the better. Hips can go from tolerable to horrid very quickly.

When my right hip started complaining I asked for an x-ray right away. After 2 x-rays all the technicians could report was a "shadow". I also had a CT that showed an area of concern. My surgeon took one look at the x-ray and pronounced AVN.

I would suggest you call the radiology area and discuss your concern with someone there. I am sure they can address your hearing issue. Some of the newer scanners don't require the patient to slide into the unit at all.

 

[Orome]

You were diagnosed via xray? I have called all the radiology departments in my area and have come up short. They tell me that all MRI's are loud, but I can double up on protection. When doubling up on protection you really only get about an additional 5db of noise reduction.

I have looked into upright (open) MRIs that I think might be a little bit quieter but my orthopedist recommended against them because according to him the images they produce are poor quality.

Looking at the xray radiology report it says "slight only very minimal if any degenerative changes of the hips" and "perhaps very slight minimal joint narrowing superiorly". I don't know what that means. I've only had the pain for a couple of weeks.

 

[Jaycey]

You were diagnosed via x-ray?

Yes I was despite 2 techicians not able to confirm AVN. My surgeon performs hundreds of THR per year and didn't need anything but the x-ray to see the deterioration.

Your x-ray report is just saying there is slight deterioration. But if you are in pain they need to confirm why. I'm not a medical expert but can you ask your orthopedist if a CT would give you the results you need?

 

[Orome]

I'll try asking that. I would rather do a CT or even a nuclear bone scan. I don't know if either one of those can catch it when it's stage 1, though.

 

[Jaycey]

Since you have a specific need for a diagnostic with no "volume" I would stress to your orthopaedic specialist that they need to get creative. Don't feel intimidated by these surgeons. They are working fast and "by the book". But you have other needs that can be addressed. No harm in being your own advocate!

 

[Orome]

Any ideas for other tests? 'Creative' to them seems to be wait and see.

 

[Carriemay60]

@Orome I am very doubtful my experience will help you but here goes. I am very claustrophobic and an MRI causes me a great deal of stress. I was allowed to choose my own music, which I did and it relaxed me at least enough to get it done. I was however still able to hear the buzzes in the background, but very faintly. Is there any type of noise you can tolerate if you are in control of choosing it?
I certainly wish you luck in getting this problem solved!

 

[Orome]

No, unfortunately it's the decibel level and not an avoidance or annoyance thing. Loud noises cause physical pain that can linger after the noise is gone, and it makes my tinnitus worse too.

I am looking at an open/upright MRI scanner that's near me. I think it might be a little bit quieter, but it's still loud. I have have heard (from my orthopedist) that their images aren't as good as closed MRI scanners.

 

[Josephine]

Orthopedist did an xray which didn't show signs of AVN but mentioned that in the early stages it doesn't always show up on an xray.

I think present day ortho surgeons are very spoiled! In my 'young day' all we had was xrays and we seemed to do pretty well with them then!

Looking at the xray radiology report it says "slight only very minimal if any degenerative changes of the hips" and "perhaps very slight minimal joint narrowing superiorly". I don't know what that means.

"slight only very minimal if any degenerative changes of the hips" means the are no gross changes in the joint but there is slight narrowing which means there is a loss of articular cartilage that shows up as abnormal.
"perhaps very slight minimal joint narrowing superiorly" that says much the same but the radiologist is being a little cautious about that he says! "superiorly" means towards the top

Can you get copies of your xrays and post them for me to see? I'm pretty nifty as reading them!


BTW, you don't need to someone's quote a post every time you reply to it. You can actually just mention their name instead. Or there is this method of calling someone's attention to the fact you're replied to them How to tag another member; how to answer when someone tags you

 

[Orome]

@Josephine

I'll see if I can get the x-rays. I have a CD they burned. Should I just upload them to the thread or can I PM them?

 

[Orome]

The images were too large to upload here, but I posted them to an album on Imgur.
Edit: it's easier to view in the imgur link than the embeded gallery, but if I post a link it embeds it.

 

[Josephine]

You need to get it up on your screen and take a screen shot. You do that by hitting the key PrtSc and then closing the cd programme and opening your image editor and pasting it by hitting Ctrl+V

 

[Orome]

I'm not sure if you were able to view the album I created, but I uploaded the original quality ones there.
Here are the screen shots in case that doesn't work.

Thanks!

 

[Josephine]

Thank you - excellent quality!

I had a good look at them and I can see AVN lesions in the right hip but nothing in the left.
The lesions I have marked are probably more like cysts than actual bony destruction but that's bad enough!

 

[Orome]

Thanks Josephine

Looking back at past medical records I just noticed the bony islands had been noted before. In an KUB x-ray that was done for kidney stones 14 months ago, the radiologist noted

There are scattered stable sclerotic lesions in the femoral head,
bilaterally, the largest lesion measuring 7.2 mm in the left femoral
head likely due to enostoses.

I don't have a copy of that x-ray.

From my understanding there are a number of different things that can cause these lesions, not just AVN, is that correct?
I'm trying to be proactive with this. What would your recommendation for a path forward be?

 

[Orome]

I actually found a KUB x-ray from 2016. I don't know if it's the right angle to compare.

Sept 2016.