EP1.1 Multidisciplinary approach to address avascular necrosis sequelae in the hip of pediatric and adolescent patients: integration of arthroscopic techniques, orthobiologic therapies, and femoral lengthening osteotomy

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ID: 331046
2026
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Abstract
Abstract Background Sequelae of avascular necrosis (AVN) of the femoral head in pediatric, adolescent, or young adult patients represent a therapeutic challenge, where the primary goal is to preserve the hip joint and delay total hip replacement as long as possible. The current trend in patients with growth potential when treating AVN sequelae (such as coxa magna, coxa plana, hinged hip, physeal arrest, among others) is to approach them in a multidisciplinary manner, combining hip arthroscopy with femoroplasty, orthobiologic therapy based on Bone Marrow Aspirate Concentrate (BMAC), and femoral osteotomies to modulate bone lengthening. Purpose Document the therapeutic approach using a combination of hip arthroscopy, orthobiologic therapies, and femoral lengthening osteotomies in pediatric or adolescent patients with sequelae of avascular necrosis of the femoral head Methods A 12-year-old female patient is described with severe sequelae of avascular necrosis of the right femoral head, resulting in premature physeal closure and loss of femoral head sphericity. Controlled pelvic measurements documented a right pelvic limb shortening of 5 mm at age 11, which progressed to 40 mm at age 12. Treatment included two surgical procedures. First, a right hip arthroscopy with femoroplasty was performed to correct deformity of the femoral head and restore femoral head sphericity, along with intra-articular application of BMAC. Subsequently, a femoral lengthening osteotomy was performed to correct the 40 mm shortening, targeting an elongation of 5 cm until closure of the contralateral hip physis. Results The patient demonstrated significant clinical improvement, with resolution of hip pain. Radiographically, restoration of femoral head sphericity was observed, along with progressive correction of femoral shortening. Discussion Hip arthroscopy in AVN sequelae among pediatric and adolescent patients offers a minimally invasive approach to correct deformities and delay total hip arthroplasty. BMAC shows potential to stimulate biological repair in osteonecrotic conditions, although evidence in pediatric populations remains limited. Lengthening osteotomies are effective in correcting significant limb length discrepancias. Conclusion This case highlights an innovative multidisciplinary approach integrating arthroscopic correction combined with orthobiologics and femoral lengthening osteotomy to manage complex deformities secondary to AVN in pediatric and adolescent patients. Early intervention targeting structural and biological factors may optimize joint preservation and delay replacement in this challenging population.
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Authors Oliverio Aguilar Hernandez, MD Antonio Porthos Salas, MD Rocío García Miranda, MD Jacek Mazek, MD David Santiago Taffinder Villarreal, MD Hector Armando Velasco Vazquez, MD Carlos Alonso Miranda Enriquez, MD Cesar Adriel Flores Ortiz, MD Diego Enrique Arriola Espinosa, MD Luis Rentería Ramírez
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Journal Journal of hip preservation surgery
Year 2026
DOI
10.1093/jhps/hnag043.185
URL
https://doi.org/10.1093/jhps/hnag043.185
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