Avascular Necrosis With Complete Fragmentation and Collapse of the Femoral Head Treated With Cementless Total Hip Arthroplasty: A Case Report

Avascular necrosis (AVN) of the femoral head results from disrupted blood flow that leads to bone tissue death. Nontraumatic risk factors include long-term corticosteroid use, excessive alcohol consumption, autoimmune diseases, and hematological disorders. Without an adequate blood supply, osteocytes die, causing microfractures that lead to structural collapse of the femoral head. Disruption of joint biomechanics causes hip or groin pain and limited range of motion (ROM). This case report presents a 56-year-old male patient with severe left hip pain and progressive functional decline over nine months. Imaging confirmed stage IV AVN with complete femoral head collapse. The patient failed initial conservative measures and underwent a cementless total hip arthroplasty (THA) augmented with peripheral screws in the acetabular cup. Post-operative recovery was unremarkable, with reported improvement of pain and increased hip motion at the six-week follow-up. This case highlights the importance of early diagnosis and treatment in advanced avascular necrosis of the femoral head. It also demonstrates the effectiveness of cementless total hip arthroplasty in providing good clinical outcomes.