PMC9608540_01
The preoperative x-ray shows cystic and sclerotic changes in the bilateral femoral heads (white arrow) (A). A series of postoperative x-ray (B, immediate), (C, 3 months), (D, 6 months), (E, 12 months), and (F, 24 months) show a gradual healing of the necrotic area at the bilateral femoral heads.
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F1
X-rays of the pelvis showed osteoporosis of the femoral head on both sides (Figure 1A). The preoperative x-ray showed cystic and sclerotic changes in the bilateral femoral heads (Figure 1A). The MRI (Figure 2I,J), CT (Figure 2F-H), and x-ray (Figures 1B-F) revealed a well-healed area of previous bone graft in the bilateral femoral heads, but there was radiological progress (slight collapse) on the left hip (Figures 1A-D).
The preoperative axial MRI shows an area of a low-intensity signal on a T1-weighted image (A) and a high-intensity signal on a T2-weighted image (B). The preoperative axial (C) and sagittal (D, right side) (E, left side) CT scans show cystic and sclerotic changes at the anterosuperior area of the bilateral femoral heads. Postoperative MRI on T1-weighted (J) and T2-weighted (I) images show a decrease of cysts and oedema in the bilateral femoral heads. The postoperative axial (H) and sagittal (F, right side) (G, left side) CT scans show that the necrotic site is partly replaced by a new bone.
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F2
Magnetic resonance imaging (MRI) revealed geographically aberrant signal intensity impairments with typical appearances of bilateral ONFH (Figures 2A,B). Computed tomography (CT) (Figures 2C-E) showed a mixed appearance, including sclerosis and cysts on the bilateral femoral heads without flattening or crescent signs. The MRI (Figure 2I,J), CT (Figure 2F-H), and x-ray (Figures 1B-F) revealed a well-healed area of previous bone graft in the bilateral femoral heads, but there was radiological progress (slight collapse) on the left hip (Figures 1A-D).
The capsule is cut longitudinally (the black arrow), and the necrotic site is located using a Kirschner pin under arthroscopic (A) and radiographic (B,C) visualization. (D) Appearance of the necrotic site before debridement. (E) Appearance of the necrotic site after debridement. (F) Arthroscopic appearance after bone particle grafting.
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F3
The necrotic site was located using a Kirschner pin under arthroscopic (Figure 3A) and radiographic (Figures 3B,C) visualization before managing ONFH. After the fluoroscopic image of the Kirschner pin location was obtained to find the center of the necrotic site at the femoral head, a cortical bone window with a diameter of approximately 1.5 cm was established at the femoral head-neck junction with a cannulated drill through the DALA portal, and the necrotic bone (Figure 3D) was removed using a rongeur and curette until bleeding or healthy bone (Figure 3E) was found. Finally, the ipsilateral auto-iliac cancellous bone was harvested and was used to fill the cavity of the femoral head (Figure 3F) through the cannula after necrotic bone removal.
Osteonecrosis of the femoral head course and management response. The timeline from presentation detailing the preoperative Harris hip score response to surgery.
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F4
The timeline for ONFH course and management response was presented in Figure 4.