JKOA Journal of the Korean Orthopaedic Association J Korean Orthop Assoc 1226-2102 2005-8918 The Korean Orthopaedic Association 10.4055/jkoa.2019.54.3.281 jkoa-54-281 Original Article Total Hip Arthroplasty in Patients with Avascular Necrosis of the Entire Femur SeungRim YiM.D., Ph.D. SeHyuk ImM.D. SangHoon ParkM.D. Department of Orthopedic Surgery, National Police Hospital, Seoul, Korea Correspondence to: Se Hyuk Im, M.D. Department of Orthopedic Surgery, National Police Hospital, 123 Songi-ro, Songpa-gu, Seoul 05715, Korea TEL: +82-2-3400-1247 FAX: +82-2-4492-2120 E-mail: ish0524@hanmail.net ORCID: https://orcid.org/0000-0003-3329-7923 12 2019 54 3 281 286 10 05 2018 19 07 2018 6 08 2018 Copyright © 2019 The Korean Orthopaedic Association 2019 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Avascular necrosis (AVN) is defined as the cellular death of bone and bone marrow components due to the loss of blood supply, and associated with post-traumatic or non-traumatic events. AVN usually involves the epiphysis of a long bone, such as the femoral and humeral heads, which are susceptible to osteonecrosis. Many studies have been conducted but they were restricted to investigations of femoral head avascular necrosis. The presence of osteonecrosis in the proximal femur may impair biological fixation after total hip arthroplasty. We report a 56-year-old male patient with avascular necrosis located not only at the femoral head, but also in the entire femur, including the medullary cavity, who underwent total hip arthroplasty 2 years earlier along with a review of the relevant literature.

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Anterioposterior (A) and frog leg lateral (B) radiographs show collapse of the right femur head and subchondral fracture.

Coronal (A) and axial (B) T2-weighted fat suppression magnetic resonance imaging show extended necrosis extended to the femur diaphysis.

Anterior and posterior view of technetium-99m bone scintigraphs showing diffuse uptake in the right femur suggesting entire femur avascular necrosis.

Right femur (A) and knee (B) T2-weighted fat suppression magnetic resonance imaging show avascular necrosis extended to the lateral femoral condyle.

(A) Postoperative anteroposterior and lateral radiographs show press-fitted femoral stem and acetabular component. (B) Four-month follow-up radiographs show calcar resorption and about 6-mm-sized subsidence is observed (white arrow). (C) Twelve-month follow-up radiographs show progress subsidence to approximately 10 mm but no further progression of subsidence is observed in the 18 months (D) and 24 months (E) follow-up radiographs.