Severe Bilateral Avascular Necrosis of Femoral Heads in an HIV-Positive Patient: A Rare Case Report and Literature Review

Introduction: Avascular necrosis (AVN) is a debilitating complication observed in HIV-positive individuals, leading to significant morbidity. Bilateral AVN of the femoral heads in an HIV-positive patient is exceptionally uncommon, with only a handful of cases documented globally.The pathogenesis involves both general risk factors and HIV-specific mechanisms. Case Presentation: A 55-year-old male from Mozambique, diagnosed with HIV 23 years ago, experienced progressive bilateral hip pain over three years. He presented with a severe waddling gait, and imaging revealed extensive destruction of both femoral heads. Laboratory tests indicated regular inflammatory markers, and histopathology showed mild chronic inflammation without malignancy. The patient underwent staged bilateral uncemented total hip arthroplasty (THA). At three months post-surgery, the patient was pain-free, able to ambulate independently, and follow-up radiographs demonstrated well-positioned prostheses. Conclusion: This case illustrates the increased risk of AVN in HIV-positive individuals and the successful use of surgical intervention to restore function. Regular monitoring of hip replacements is crucial for long-term success.