Focal anatomic resurfacing implantation for bilateral humeral and femoral heads’ avascular necrosis in a patient with Hodgkin’s lymphoma and literature review

• The avascular necrosis mostly affects young and middle-aged patients.
• The optimum treatment has not been established, yet.
• The focal anatomic resurfacing implantation has recently gained popularity.
• The main advantage is the preservation of the joint’s anatomy and function.
• These particular implants functioned well in this particular case of four joints.

IntroductionThe femoral and humeral heads are among the most common sites of osteonecrosis. The aims of this case report was to report three years’ results for sequential treatment of bilateral, concomitant involvement of humeral and femoral heads with focal anatomic resurfacing implantation in a single patient with Hodgkin’s lymphoma and to review the relevant literature, which is relatively scarce.Presentation of caseWe present a 48-year-old male patient with concomitant, bilateral femoral and humeral head avascular necrosis. He was diagnosed as Hodgkin’s lymphoma in 1984. He had bilateral groin and shoulder pain, lasting for three years and aggravated by joint motions. Radiological evaluations demonstrated bilateral focal osteonecrosis of femoral heads and humeral heads, respectively. Despite conservative treatment, he did not obtain any symptomatic relief. Following the common decision, he was treated with sequential implantations with the HemiCAP® device for both bilateral pathologies, by a single surgeon and standard surgical approaches. Neither intraoperative nor postoperative complication was encountered. After the follow-up period of 36 months after the last surgery, he was symptomless and with normal range of motion for all four joints.DiscussionThe bilateral, concomitant involvement of humeral and femoral head in the setting of avascular necrosis is relatively rare. Moreover, the optimal treatment method at earlier stages, in young patients has not been established yet.ConclusionThis study is the first report to present the three-years’ clinical result of a single, relevant case, who was treated with sequential focal anatomic resurfacing implantations (HemiCAP®) in four aforementioned joints.