Rare clinical image of chronic bilateral lymphatic filariasis with secondary bilateral hip osteonecrosis

Osteonecrosis of the femoral head (ONFH) is a progressive disorder caused by vascular compromise to subchondral bone, leading to joint collapse and disability. It is associated with multiple risk factors, but its coexistence with chronic lymphatic filariasis is rarely reported. Early diagnosis and management are crucial to prevent irreversible hip destruction. This case highlights the rare association of chronic lymphatic filariasis with bilateral femoral head osteonecrosis, the limited benefit of core decompression in advanced disease. A 52-year-old male, known case of bilateral lymphatic filariasis for forty years, presented with progressive dull aching pain in the right hip and difficulty in ambulation for one year. The pain was progressive, aggravated by weight-bearing and relieved by rest. Six months earlier, he had undergone core decompression with bone grafting, without symptomatic relief. Subsequently, symptoms worsened with functional limitation. Radiographs revealed bilateral avascular necrosis of femoral heads (R>L), and the patient underwent right total hip arthroplasty with physiotherapy rehabilitation.