# Silent Avascular Necrosis of the Femoral Head in Severe Hemophilia A: A Case Report

## TL;DR

A man with severe hemophilia A developed silent avascular necrosis in his hip, highlighting the need for better screening in patients with limited access to regular treatment.

## Contribution

This case report emphasizes silent avascular necrosis in hemophilia patients and advocates for routine hip screening in resource-limited settings.

## Key findings

- A 32-year-old man with severe hemophilia A was diagnosed with silent avascular necrosis of the femoral head.
- The patient had a history of inadequate prophylaxis and advanced joint disease due to socioeconomic barriers.
- The case underscores the importance of hip screening for early detection in hemophilia patients.

## Abstract

Avascular necrosis (AVN) of the femoral head is a rare but serious complication in patients with hemophilia. While hemarthroses commonly affect the knees, elbows, and ankles, hip involvement is less frequent and often overlooked, leading to delayed diagnosis, especially when presentation is silent. We report a case of a 32-year-old man with severe hemophilia A, diagnosed at age 11, who presented with progressive limp and right hip pain for six weeks. His treatment history revealed lifelong on-demand factor VIII replacement due to financial constraints, with multiple joint bleeds resulting in advanced hemophilic arthropathy. Despite a high Hemophilia Joint Health Score (HJHS) and a low Functional Independence Score in Hemophilia (FISH), he had never reported hip symptoms previously. Socioeconomic hardship, a lack of education, and complex family issues further hindered regular prophylaxis. Imaging with a computed tomography (CT) scan revealed avascular necrosis of the right femoral head. This case highlights the need for heightened awareness of silent AVN in persons with hemophilia, especially those on inadequate prophylaxis and with advanced joint disease. Routine hip screening should be a part of comprehensive musculoskeletal surveillance to detect early changes and enable timely intervention, ultimately preserving joint function and quality of life in resource-limited settings.