Information

Over the past calendar year, there has been a marked increase in cases of avascular necrosis of the femoral head - Morbus Chandler.

This condition has an unclear etiology, but its pathogenesis involves disruption of the blood supply to a section of the femoral head, leading to necrosis of that section and deformation of the head. The later consequences are destruction of the hip joint.

There are various hypotheses as to what causes this condition. Statistically, it has been established that steroid use, smoking, lipid metabolism disorders, and increased intraosseous pressure raise the risk of Morbus Chandler.

The increase in reported cases in recent months may be attributed to the increased use of steroids in the treatment of COVID-19, as well as still-unproven data suggesting it is a side effect of vaccination.

The diagnosis of avascular necrosis of the femoral head is rarely considered on initial examination, since the symptoms often overlap with the most common condition - low back pain (lumbalgia).

In the early stages, the condition progresses without significant symptoms. As it progresses, pain in the inguinal canal is observed, accompanied by limited and painful movement in the hip joint, lower back pain, and other symptoms.

The affected bone gradually undergoes necrosis, sinks in, and the femoral head collapses, a process accompanied by joint pain and limitation of movement.

Early diagnosis is of vital importance for the successful treatment of Morbus Chandler. In the early stages of the condition, small lesions are observed, the femoral head is not yet fully destroyed, and there is a chance the joint can be saved.

If this diagnosis is suspected, it is best to initially perform an MRI, on which changes in the femoral head can be seen even if no such signs are yet visible on an X-ray.

In the Department of Orthopedics and Traumatology at VITA Hospital, the "osteoinduction" method has been used for more than 10 years: under X-ray guidance, the area of osteonecrosis is reached and an autologous bone graft plus PRP is implanted. This surgical technique aims to restore the necrotic area and replace it with healthy bone.

The most successful results are achieved when this method is applied in the early to intermediate stages (up to stage three-four). The surgical risks are relatively low, since the procedure does not pass through richly innervated and vascularized areas.

The postoperative period includes sparing the limb (walking with crutches) for 10-15 days. Oral treatment with medications that support the mineralization of the newly forming bone may also be added.

Avascular necrosis of the femoral head more often affects men and women between 30 and 50 years of age. The condition can affect only one joint or occur bilaterally (in about 60% of cases). The second joint is often affected anywhere from several months to 2-3 years after the first. For this reason, monitoring of the healthy joint is necessary (MRI every 6 months).