Method for minimally invasive multiple tunnelization of the femoral head in case of its aseptic necrosis

BACKGROUND: Aseptic necrosis of the femoral head (ANFH) is a serious disease that often affects young and middle-aged people (20–50 years) and accounts for up to 4.7% of degenerative-dystrophic hip disorders. In its late stages, it usually leads to destruction of the femoral head and functional failure of the hip joint as a whole due to impaired blood supply and low bone remodelling capacity. The clinical picture in the early stages of ANFH is often asymptomatic, although patients may develop groin pain that may radiate into the knee joint or ipsilateral buttock. On physical examination, patients usually have limited range of motion in the hip joint and pain on forced internal rotation. Modern diagnostic methods available include radiography, scintigraphy, functional bone assessment, computed tomography, histological studies and magnetic resonance imaging (MRI), which has recently become the most widely used by many clinicians. Early signs of osteonecrosis can only be detected by MRI, which allows the most accurate determination of the stage of the pathological process, assessment of the prevalence of the lesion, structural changes in the bone marrow, the presence of fluid in the joint, the state of the articular cartilage and other soft tissues of the hip joint. Contrast MRI shows delayed perfusion of the contrast agent in the necrosis zone. CLINICAL CASE DESCRIPTION: The article describes an original method of organ-preserving surgery — minimally invasive multiple tunneling of the femoral head with aseptic necrosis without collapse, and presents a clinical observation. The positive outcome of the surgical procedure was confirmed functionally (preservation of the range of motion of the operated joint, absence of pain syndrome) and by MRI data (preservation of the shape of the femoral head, signs of remodelling of the necrosis focus). CONCLUSION: At present, the diagnostic possibilities of detecting aseptic necrosis of the femoral head at the pre-radiological stage are becoming a routine examination due to the increasing availability of MRI in the medical and preventive facilities. With the emergence of new technological possibilities in modern medicine, minimally invasive treatment of the lesion by multiple tunnelling to improve blood circulation in combination with cellular stimulation of reparative processes with growth factors in the femoral head makes it possible to preserve the viability of the femoral head and avoid joint endoprosthesis.