Radiological Evaluation Of Combined Surgical And Medical Modalities Of Treatment In Precollapsed Avascular Necrosis Of Femoral Head

Swapnil Mathur; Mahendra Solanki; Abhishek Pal

doi:10.36948/ijfmr.2025.v07i06.64520

Radiological Evaluation Of Combined Surgical And Medical Modalities Of Treatment In Precollapsed Avascular Necrosis Of Femoral Head

Author(s)	Dr. Swapnil Mathur, Dr. Mahendra Solanki, Dr. Abhishek Pal
Country	India
Abstract	Introduction: Avascular necrosis of the femoral head, also referred to as osteonecrosis, is a progressive and debilitating condition characterized by compromised vascular supply leading to bone ischemia, structural weakening, and eventual collapse of the femoral head. In the absence of timely intervention, the disease advances to joint dysfunction and secondary osteoarthritis. The present study aimed to arrest disease progression at an early stage through a structured interventional approach. Material & methods: a total of 60 patients (80 hips) with early-stage avascular necrosis of the femoral head (modified Ficat-Arlet stage one and two-A), aged over 18 years, were included in the study. Following detailed history-taking and clinical examination, diagnostic confirmation was obtained through radiographic evaluation with X-ray and MRI. After obtaining informed consent, all patients underwent core decompression with autologous bone grafting in combination with pharmacotherapy. Radiological outcomes were assessed by comparing kerboul’s combined necrotic angle on MRI preoperatively and at 12 months postoperatively. Results: Our study demonstrated that kerboul’s combined necrotic angle remained stable following intervention, with no statistically significant change sufficient to alter the patients’ risk stratification category. Notably, the absence of progression in the necrotic angle indicates that disease advancement was effectively arrested or at least mitigated. Conclusion: In the present cohort, the majority of patients manifested with stage one avascular necrosis, predominantly of idiopathic origin. The multimodal therapeutic strategy comprising core decompression, autologous bone grafting, and adjunctive pharmacotherapy yielded substantial clinical improvement and effectively mitigated the risk of femoral head collapse, thereby decelerating disease progression when instituted at an early stage. Radiological outcomes were systematically assessed through quantification of kerboul’s combined necrotic angle on MRI, providing an objective measure of structural preservation.
Keywords	Avascular Necrosis, Bone Grafting, Core Decompression, Femoral Head, Kerboul’s Combined Necrotic Angle, Pharmacotherapy, Precollapse Stage
Field	Biology
Published In	Volume 7, Issue 6, November-December 2025
Published On	2025-12-25
DOI	https://doi.org/10.36948/ijfmr.2025.v07i06.64520

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Radiological Evaluation Of Combined Surgical And Medical Modalities Of Treatment In Precollapsed Avascular Necrosis Of Femoral Head

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