Modified femoral neck rotational osteotomy with supercapsular approach as hip preservation surgery technique for osteonecrosis of femoral head in young patient: A case report

INTRODUCTION: Osteonecrosis of Femoral Head (ONFH) is a debilitating condition with multiple contributory etiological factors that can lead to significant hip pain and disability. All attempts should be taken to save the joint and postpone or avoid the necessity for a total hip arthroplasty (THA), particularly in young and active individuals. CASE PRESENTATION: A 21-year-old female with 5-year history of Systematic Lupus Erythematosus (SLE) and long-term use of corticosteroids presented with left hip pain and limping that worsening over the past two months. She had a Leg Length Discrepancy (LLD) of 1 cm. After radiological examination, she was diagnosed with left ONFH FICAT II-III ARCO stage 3. The measured Kerboul angle was 180(0), indicating a medium necrotic area. We performed joint preservation surgery through Femoral Neck Rotational Osteotomy (FNRO) using Hip Supercapsular Approach. On a 3-month evaluation, the patient's pain improved significantly, and radiographic evaluation showed good healing of the osteotomy site. DISCUSSION: FNRO is a joint preservation surgery technique that aims to improve vascularization by moving the area of necrosis away from the weight-bearing region. The Hip Supercapsular Approach was chosen due to numerous advantages, such as short incisions, preservation of blood supply to the femoral head, and clear visualization of both necrotic lesion and healthy bone and cartilage. CONCLUSION: Modified FNRO with Hip Supercapsular approach may be a promising surgical procedure for young patients with ONFH. It yields favorable results in terms of pain alleviation, improvement in joint functionality, and radiological outcomes while maintaining a minimally invasive setting.