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Close relationships exist among subchondral fractures, ONFH-associated BME of the proximal femur, worsening of clinical symptoms and signs, hip joint effusion, and the ultimate collapse of the femoral head [Figure 2].[18],[19],[20],[21],[22],[23],[24],[25],[26],[27],[32],[33],[34],[35] In fact, the latter four phenomena may occur secondary to subchondral fractures, which forecast the progression of structural instability of the femoral head.{Figure 2}
Joint effusion is present distending the joint capsule, without any sign of menisci or ligaments' injury, or osseous erosions.
The periosteal bony reaction that occurs at distal tubular bones, particularly the tibia and fibula (less frequently at the radius and ulna), which sometimes leads to adjacent joint effusion is one of the striking features.
Joint effusion, osteophytes, and synovial thickening was seen in 2 cases (67%).
MRI left knee confirmed the presence of joint effusion and osteoarthritis changes.
The MR images revealed extensive edema within the medullary bone of the head and neck of the left femur with an associated joint effusion. No findings suggestive of avascular necrosis, labral tear or intra-articular lesion were identified.
Joint effusion (JE) is generally defined as a pathological collection of fluid in articular spaces.
Physical examination revealed localized increase in temperature of the skin, a large joint effusion, and decreased range of motion.
The range of joint motion was slightly limited, and there was no knee joint effusion. Laboratory tests showed increased levels of white blood count, erythrocyte sedimentation rate, and C-reactive protein.
Notably, the frequency of a purulent joint effusion was 50% in pregnant women and 70% in nonpregnant women--reflecting the fact that the duration of symptoms was approximately 3 days shorter in pregnant women than in nonpregnant women.
In addition to the Kocher criteria, other signs and symptoms of septic arthritis include limb pain, joint effusion, and a strong tendency for the patient to hold the affected joint in the position of maximal intracapsular volume in order to minimize discomfort.
There was no demonstrable joint effusion and the knee was stable.

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