Bilateral Avascular Necrosis of the Femoral Heads Secondary to Familial Hyperlipidemia

Avascular necrosis (AVN) is a progressive disease characterized by bone death secondary to an interruption of the relevant vascular supply. While it is most common in pediatrics and later adulthood, it can occur at any age. This case describes a previously healthy man in his mid-twenties who presented with worsening hip pain. Imaging, including X-ray and magnetic resonance, revealed severe marrow edema and early collapse of the femoral head. The patient was also found to have a severely elevated low-density lipoprotein level, leading to the diagnosis of AVN due to familial hyperlipidemia. He received a total hip arthroplasty and was started on high-intensity statin therapy. This case highlights the importance of considering AVN in the young adult population with hip pain as well as the appropriate workup and treatment.