Presentation
Referred for follow-up after bilateral femoral head avascular necrosis treatment.
Patient Data
Stigmata of previous core decompression is visible at both femoral heads.
On the right side: double-line sign of femoral head AVN with peripheral bone marrow oedema. According to Shimizu et al. classification 2, the extent of femoral head necrosis is measured as less than 1/4 of femoral head diameter (grade A), involving more than 2/3 of the weight-bearing articular margin of the femoral head (grade B). Bone marrow shows mixed T1 signal intensity at the region of AVN (grade β).
On the left side: double-line sign of femoral head AVN with peripheral bone marrow oedema. The extent of femoral head necrosis is measured between 1/4-1/2 of femoral head diameter (grade B), involving more than 2/3 of the weight-bearing articular margin of the femoral head ( grade C). Bone marrow shows low T1 signal intensity at the region of AVN (grade γ). Minimal surface collapse of the femoral head with early degenerative changes of the hip joint is noted.
Case Discussion
Avascular necrosis of the femoral head more commonly affects young and middle-aged populations. The main surgical procedure for the treatment of early femoral head AVN stages is core decompression.
This procedure is done by drilling the necrotic bone, thus reducing the intraosseous pressure and relieving pain. The main goal of this procedure is to prevent the articular surface of the femoral head from collapsing.
Clinical and imaging follow-up are used after core decompression to evaluate the treatment's success.
This case represents post-core decompression femoral head changes.