Journal of IMAB - Annual Proceeding (Scientific Papers)
Publisher: Peytchinski Publishing Ltd.
ISSN:
1312-773X (Online)
Issue:
2025, vol. 31, issue2
Subject Area:
Medicine
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DOI:
10.5272/jimab.2025312.6291
Published online: 18 June 2025
Case report
J of IMAB. 2025 Apr-Jun;31(2):6291-6294
ASEPTIC NECROSIS OF FEMORAL HEAD IN PATIENT AFTER VIRAL INFECTION, TREATED FOR A HERNIATED DISC
Gergana Gecheva-Fermendzhieva


,
Physiotherapy and Rehabilitation Department, Trakia University, Stara Zagora, Bulgaria.
ABSTRACT:
This case presents a patient with severely painful and limited gait when he was addmitted to the Department of Physical and Rehabilitation medicine. The complains of limited gate and pain in the area of hips gradually increased over a year after a severe viral infection that was treated with corticosteroids. At the beginning the complaints were in the lower back area which is why the patient underwent an MRI of the lower back where changes in the intervertebral discs were detected. The patient began a treatment for herniated disk which had a temporary and insufficient effect. When admitted to the Department, X-Ray images of hips were taken and the patient was diagnosed with aseptic necrosis of the hip's head known as Morbus Chandler. The case presents a successful rehabilitation due to correct diagnosis, made before beginning any rehabilitation and subsequently referring the patient for surgical treatment
Aim. The aim is to highlight the importance of correct diagnosis for successful rehabilitation of aseptic necrosis of the hip joints.
Materials and methods: One 68-yaers male was included in this study. X-RAY of pelvis and MRI of lumbar area were performed. Neurological and orthopedic examination and gait assessment were performed.
Result: The patient was correctly diagnosed and referred to surgical treatment. Intensive rehabilitation and kinesiotherapy were performed, which restored the patient's general condition and improved his gait.
Conclusion: We consider it necessary to recall that the symptoms of a herniated disc and hip joint diseases overlap in most cases and it is of utmost importance in differential diagnosis to distinguish. A pelvic X-ray or hip MRI is necessary to make the diagnosis and differentiation.
Keywords: aseptic head necrosis of femur, X-RAY, MRI, Chandler disease, herniated disk, COVID-19,
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Please cite this article as: Gecheva-Fermendzhieva G. Aseptic necrosis of femoral head in patient after viral infection, treated for a herniated disc. J of IMAB. 2025 Apr-Jun;31(2):6291-6294. [Crossref - 10.5272/jimab.2025312.6291]
Correspondence to: Dr Gergana Gecheva – Fermendzhieva, Medical center “Pavel banya” ltd.; 16, Petko Kolev Str., Pavel banya, Bulgaria; E-mail: dr.ggecheva@abv.bg
REFERENCES:
1. Wong SW, Steeples LR, Jones NP. Avascular Necrosis of Bone in Patients with Uveitis Treated with Systemic Corticosteroids. Ocul Immunol Inflamm. 2022 May 19;30(4):869-875. [PubMed ]
2. Goncharov EN, Koval OA, Nikolaevich Bezuglov E, Aleksandrovich Vetoshkin A, Gavriilovich Goncharov N, Encarnación Ramirez MJ, et al. Conservative Treatment in Avascular Necrosis of the Femoral Head: A Systematic Review. Med Sci (Basel). 2024 Jul 2;12(3):32. [PubMed]
3. Weldon D. The effects of corticosteroids on bone: osteonecrosis (avascular necrosis of the bone). Ann Allergy Asthma Immunol. 2009 Aug;103(2):91-7; quiz 97-100, 133. [PubMed]
4. Assouline-Dayan Y, Chang C, Greenspan A, Shoenfeld Y, Gershwin ME. Pathogenesis and natural history of osteonecrosis. Semin Arthritis Rheum. 2002 Oct;32(2):94-124. [PubMed]
5. Tsai HL, Chang JW, Lu JH, Liu CS. Epidemiology and risk factors for avascular necrosis in childhood systemic lupus erythematosus in a Taiwanese population. Sci Rep. 2020 Sep 23;10(1):15563. [PubMed]
6. Tsai HL, Chang JW, Lu JH, Liu CS. Epidemiology and risk factors associated with avascular necrosis in patients with autoimmune diseases: a nationwide study. Korean J Intern Med. 2022 Jul;37(4):864-876. [PubMed]
7. Basyal B, Bhandari B, Derk CT. Avascular necrosis in systemic sclerosis patients: a case-based review of demographics, presentation, and management. Clin Rheumatol. 2021 Jan;40(1):399-405. [PubMed]
8. George G, Lane JM. Osteonecrosis of the Femoral Head. J Am Acad Orthop Surg Glob Res Rev. 2022 May 1;6(5):e21.00176. [PubMed]
9. Assad SK, Sabah M, Kakamad FH, Salih AM, Salih RQ, Mohammed SH, et al. Avascular necrosis of femoral head following COVID-19 infection. Ann Med Surg (Lond). 2023 Jul 25;85(9):4206-4210. [PubMed]
10. Mankin HJ, Brower TD. Bilateral idiopathic aseptic necrosis of the femur in adults: "Chandler's disease". Bull Hosp Joint Dis. 1962 Apr;23:42-57. [PubMed]
11. Hassan AAA, Khalifa AA. Femoral head avascular necrosis in COVID-19 survivors: a systematic review. Rheumatol Int. 2023 Sep;43(9):1583-1595. [PubMed]
Published online: 18 June 2025
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