Idiopathic avascular necrosis of the femoral head in young rhythmic gymnasts: a clinical and radiological assessment

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Abstract

BACKGROUND: Osteonecrosis of the femoral head is a severe and rapidly progressive degenerative-dystrophic disorder and is commonly detected in children professionally engaged in rhythmic gymnastics. It is characterized by destructive changes in the femoral head, resulting in hip joint function impairment and, consequently, poor clinical outcomes. The radiographic anatomy of the hip joints is insufficiently studied, especially considering the impact of intense and specific physical loads, course and progression of the disease, and reasons behind its delayed diagnosis and late initiation of treatment.

AIM: To provide a clinical and radiological characterization of the hip joints in young rhythmic gymnasts diagnosed with idiopathic avascular necrosis of the femoral head and identify factors contributing to delayed diagnosis and late treatment initiation.

METHODS: Medical histories and imaging findings of 45 young rhythmic gymnasts aged 12–17 years diagnosed with idiopathic avascular necrosis of the femoral head were analyzed.

RESULTS: Most patients exhibited a severe clinical course due to total or subtotal involvement of the femoral head. Distinctive anatomical features of the hip joint in young rhythmic gymnasts included dysplastic morphology with impaired stability indices, valgus epiphyseal formation resembling a Kalamchi type II deformity, and a tendency toward acetabular retroversion. These characteristics contributed to the development of pathological changes, such as femoral head extrusion and deformation. Delayed diagnosis and initiation of treatment was due to insufficient awareness of this pathology among parents, coaches, and physicians; gradual development of clinical symptoms without a history of overt trauma; and diagnostic errors during the early stages of the disease.

CONCLUSION: In adolescents, their congenital anatomical features of the hip joint contribute to a more severe course of avascular necrosis of the femoral head. Early differential diagnosis of hip pain in gymnasts, including the use of magnetic resonance imaging, is crucial to exclude femoral head osteonecrosis.

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About the authors

Ivan Y. Pozdnikin

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

Author for correspondence.
Email: pozdnikin@gmail.com
ORCID iD: 0000-0002-7026-1586
SPIN-code: 3744-8613

MD, PhD, Cand. Sci. (Medicine)

Russian Federation, Saint Petersburg

Pavel I. Bortulev

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

Email: pavel.bortulev@yandex.ru
ORCID iD: 0000-0003-4931-2817
SPIN-code: 9903-6861

MD, PhD, Cand. Sci. (Medicine)

Russian Federation, Saint Petersburg

Dmitrii B. Barsukov

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

Email: dbbarsukov@gmail.com
ORCID iD: 0000-0002-9084-5634
SPIN-code: 2454-6548

MD, PhD, Cand. Sci. (Medicine)

Russian Federation, Saint Petersburg

Tatiana V. Murashko

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

Email: popova332@mail.ru
ORCID iD: 0000-0002-0596-3741
SPIN-code: 9295-6453

MD

Russian Federation, Saint Petersburg

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Supplementary files

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2. Fig. 1. Comparison of the range of motion in the hip joints of the examined patients.

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3. Fig. 2. Distribution of patients by stages of osteonecrosis according to the Association Research Circulation Osseous classification.

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4. Fig. 3. X-ray images of the hip joints of patient G., 15 years old (a) and patient B., 12 years old (b). Diagnosis: idiopathic aseptic necrosis of the femoral head on the right. Indicative changes in the proximal femur of the unaffected hip joint (a, left: horizontal position of the epiphysis growth zone, "waist" of the neck), "borderline" according to the Wiberg angle (a) and true (b) acetabular dysplasia of the hip joint. On the affected side: extrusion of the femoral head (b, right); decrease in the distance between the lesser trochanter and the pelvic bone (a, right).

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5. Fig. 4. Radiographs (a, b) and magnetic resonance imaging (c) of patient M., 14 years old. Diagnosis: idiopathic aseptic necrosis of the femoral head on the right. Deformation and extrusion of the femoral head on the right. Coxarthrosis of grades II–III. Synovitis, deformation of the cartilaginous structures of the joint (c).

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6. Fig. 5. Radiographs (a, b) and magnetic resonance imaging (c) of patient A., 12 years old. Diagnosis: idiopathic aseptic necrosis of the left femoral head. Deformation of the femoral head (intra-articular type) of the affected hip joint (shown by the arrow).

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