Femoral head chondral delamination injury and associated osteonecrosis: A case report of treatment

Avascular necrosis can develop secondary to a traumatic or atraumatic interruption of blood supply to a bony region. We present an unusual case of femoral head osteonecrosis in a patient who concomitantly suffered a complete delamination injury to the articular surface and ultimately underwent progressive degenerative changes in the femoral head requiring total hip arthroplasty (THA). A 57-year-old man without significant medical comorbidities presented for orthopedic evaluation in the outpatient setting complaining of left hip pain. The patient reported a slip and fall onto his left hip 4 months prior with no preexisting discomfort. Since then, the progressively worsening pain has centered on the left groin with radiation into the lateral aspect of the hip. Physical examination is negative for focal deficits, but provocative maneuvers for intra-articular pathology were positive. X-rays demonstrated mild degenerative changes while magnetic resonance imaging (MRI) showed a complete delamination injury to the articular surface with associated femoral head collapse. Nonoperative treatment failed to provide pain relief, and so the patient ultimately underwent surgical intervention. Treatment consisted of left uncemented THA with cable augmentation. Postoperatively, the patient was monitored with periodic follow-ups while undergoing postsurgical rehabilitation. Interval improvement was demonstrated and patient overall did well.