Avascular femoral head necrosis in the context of gymnastics is a rare but serious complication, appearing similar to Perthes’ disease but occurring later during adolescence. Based on 3D CT animations, we propose repetitive impact between the main supplying vessels on the posterolateral femoral neck and the posterior acetabular wall in hyperextension and external rotation as a possible cause of direct vascular damage, and subsequent femoral head necrosis in three adolescent female gymnasts we are reporting on. Outcome of hip-preserving head reduction osteotomy combined with periacetabular osteotomy was good in one and moderate in the other up to three years after surgery; based on the pronounced hip destruction, the third received initially a total hip arthroplasty.Aims
Methods
Femoral head necrosis in the context of high impact gymnastics of young adolescents is rare but seems a more serious complication compared to a Perthes like necrosis. Between 2017 and 2019, three young females aged from12 to 14 years were referred due incapacitating hip pain and severe collapsing femoral head necrosis. The indication of hip preserving surgery was based on the extent of the necrosis, presence of a vital lateral pillar and joint subluxation. In one of our 3 cases total head involvement made THR necessary, which was performed elsewhere. In the remaining 2 cases, head reduction osteotomy plus periacetabular osteotomy led to a good and a fair result. Repetitive impact between the main supplying vessels on the posterolateral femoral neck and the posterior acetabular wall in hyperextension/ external rotation could be the cause of severe femoral head necrosis in three adolescent female gymnasts we are reporting on. Supra-selective angiography or sonography may be helpful to improve indication. Targeted adaptation of training methods should be discussed. Due to the severe vascular insult, results have to be considered moderate.
