A Case of Bilateral Aseptic Necrosis of the Femoral Head

Abstract

Aseptic necrosis of the femoral head is a disease whose etiology is not completely elucidated and generally affects young adults aged between 30 and 50 years. In a significant number of patients bilateral disease occurs, which makes detection in its early stages constitute an important objective. We present the case of a male patient, aged 23 years, with the following risk factors: smoking and chronic alcohol consumption, who is diagnosed with aseptic necrosis of the left femoral head, ARCO stage IV, and in just six months after the diagnosis and hip arthroplasty, he suffers an injury which leads to the same diagnosis in the contralateral hip. We want to emphasize that for all patients with a high index of suspicion there should be an MRI examination, because the plane radiographs or CT are most often not relevant in detecting early signs of this condition. Diagnosis of aseptic necrosis of the femoral head in the early stages is a necessity in order to obtain an optimal result of conservative treatment.

Keywords: MRI; aseptic necrosis; femoral head.

Fig.1

Coxal X-ray. It can be seen marked narrowing of the left coxal-femoral joint space, left femoral head deformation, circumscribed areas at the femoral neck, anterior-superior region and subchondral bone attachment aspect.

Fig.2

Coxal CT - left coxo-femoral articular effusion with edema and bone sclerosis aspect, the presence of cysts, microfractures in the left femoral head. The collapse of the femoral head and joint degeneration in the left coxo-femoral joint.

Fig.3

Coxal CT - left coxo-femoral articular effusion with edema and bone sclerosis aspect, the presence of cysts, microfractures in the left femoral head. The collapse of the femoral head and joint degeneration in the left coxo-femoral joint.

Fig.4

Coxal CT - left coxo-femoral articular effusion with edema and bone sclerosis aspect, the presence of cysts, microfractures in the left femoral head. The collapse of the femoral head and joint degeneration in the left coxo-femoral joint.

Fig.5

Coxal CT - left coxo-femoral articular effusion with edema and bone sclerosis aspect, the presence of cysts, microfractures in the left femoral head. The collapse of the femoral head and joint degeneration in the left coxo-femoral joint.