Possibilities of MR diagnostics in assessing the dynamics of avascular necrosis of the hip joints in a patient who has had COVID-19 during treatment with bone marrow tunnelization

Full Text

Introduction. Acute respiratory infection caused by coronavirus SARS-CoV-2 (2019-nCoV) is characterized by both pulmonary and a large number of extrapulmonary complications. Aseptic necrosis of the femoral head (AFH), which occurs after COVID-19, causes severe pain and limited function in large joints. MRI studies of the hip joints should be included in the examination algorithm for such patients if they have persistent joint pain, since T1-weighted MRI is used for staging osteonecrosis based on the location of the necrotic lesion [1].

Treatment of aseptic necrosis of the femoral head is carried out using surgical and non-surgical methods. Methods of minimally invasive surgical treatment include various options for decompression of the metaepiphysis of the femur [2]. In most cases, it allows you to achieve remission at an early stage of the disease.

Goal of the work. To provide an idea of ​​the possible dynamics of aseptic necrosis of the head of the femur in a patient who had COVID-19 during treatment with bone marrow tunneling.

Materials and methods of research. Various features of an MRI study of a clinical case of the development of bilateral avascular necrosis of the femoral heads (arising after a new coronavirus infection (COVID-19)), with signs of persistent pain in the hip joints, were analyzed and studied. The patient underwent an MRI examination of the hip joints at the pre- and postoperative stages of examination as part of the diagnosis, staging and monitoring of avascular necrosis.
Research results. After minimally invasive surgical treatment and decompression of the femoral metaepiphyses, an MRI study was performed using standard scanning protocols in the axial, sagittal, and coronal planes.
According to preoperative MR examination data from 2022. It was established: bilateral osteonecrosis of the femoral heads (stage 3 on the left, stage 2 on the right). Arthrosis of the hip joints, stage 2. Synovitis of the left hip joint.
The patient underwent minimally invasive surgery with composite implantation.
When monitoring after 3 months and one year, negative MR dynamics were visualized due to an increase in areas of aseptic destruction with deformation of the articular surfaces, an increase in areas of edema in the heads and necks (extending them to the intertrochanteric region) of the femurs.
Currently, several classifications of ANFH are used. They are based on dividing the process into early stages, when the impression of the femoral head has not yet occurred and post-impression late stages of the disease. The choice of treatment tactics depends on this gradation. Diagnosis of ANFH in the early stages is often difficult. Stage I: no radiological changes. The lesion is determined by radionuclide scanning and/or magnetic resonance imaging (MRI).
An MR study is also performed for the purpose of dynamic quality control of decompression, visual assessment of the cartilaginous surface of the head over the necrosis zone and the initial signs of subchondral bone collapse. It is also necessary to study the dynamics after decompression. The volume of osteonecrosis, control of bone marrow edema of the femoral head, and severity of synovitis of the hip joint are assessed. This may affect further treatment tactics.
Conclusion. Due to the recent high prevalence of COVID-19 and its large number of extrapulmonary complications, including ANFH, bone marrow tunneling can give multidirectional dynamics, which is clearly visualized during an MR study. MRI in standard modes allows one to obtain reliable information about the localization and extent of lesions in patients with ANFH, which allows staging osteonecrosis based on the localization of the necrotic lesion and assessing the dynamics.

About the authors

Daria Pavlovna Ryazanovа

Voronezh State Medical University named after N.N. Burdenko

Author for correspondence.
Email: darpavlovna1997@mail.ru
ORCID iD: 0009-0005-8603-7422

first-year resident in the specialty of radiology

Russian Federation, 394036, Russia, Voronezh, 10 Studentskaya str.,

Anna Vladimirovna Samarchenko

Voronezh State Medical University named after N.N. Burdenko

Email: a-samarchenko@list.ru
ORCID iD: 0009-0009-8373-4256

first-year resident in the specialty of radiology

Russian Federation, 394036, Russia, Voronezh, 10 Studentskaya str.,

Andrey Aleksandrovich Gritsai

Voronezh State Medical University named after N.N. Burdenko

Email: x-ray73@mail.ru
ORCID iD: 0009-0004-8237-3907

PhD., Associate Professor of the Department of Instrumental Diagnostics

Russian Federation, 394036, Russia, Voronezh, 10 Studentskaya str.

Anna Yuryevna Goncharova

Voronezh State Medical University named after N.N. Burdenko

Email: goncharova.g02@yandex.ru
ORCID iD: 0000-0002-0719-8078

Assistant of the Department of Instrumental Diagnostics

Russian Federation, 394036, Voronezh, 10 Studentskaya str.

References

Supplementary files

There are no supplementary files to display.