Idiopathic aseptic necrosis of the femoral head in children who are professionally engaged in gymnastics: A literature review

BACKGROUND: Aseptic necrosis of the femoral head in school-age children is a severe, rapidly progressive degenerative and dystrophic disease. A significant proportion of girls aged 10 years with osteonecrosis of the femoral head have been professionally engaged in rhythmic gymnastics. The relationship between professional sports, in particular rhythmic gymnastics, and the development of this pathology and the mechanism of impaired blood flow in the femoral head in such cases remains unclear. The severity of the course and serious consequences of this disease in the form of multidimensional deformities of the femoral head, early arthrosis of the hip joint, and persistent disability, require close attention. AIM: To analyze modern world literature data on the etiology, pathomechanics, and features of the course and treatment of idiopathic aseptic necrosis of the femoral head in children professionally engaged in rhythmic gymnastics. MATERIALS AND METHODS: A literature search on the problem of idiopathic aseptic necrosis of the femoral head in children professionally engaged in rhythmic gymnastics in the open information databases was conducted in PubMed, Science Direct, and Library with an analysis depth of 20 years. RESULTS: The analysis of publications on the osteonecrosis of the femoral head allowed us to talk about the etiological connection of this condition with professional rhythmic gymnastics, namely, high-intensity repetitive loads on the hip joint of a child. Studies using in vivo laser Doppler flowmetry and 3D computer modeling prove the occlusion of blood vessel branches encircling the femur under excessive mechanical stress on the femoral head and potentially unfavorable positions in the hip joint – overextension (hyperextension), external rotation, and abduction. CONCLUSIONS: Professional gymnastics can be a risk factor for the development of osteonecrosis of the femoral head. Frequent late disease diagnoses with the development of severe deformity of the femoral head and end-stage coxarthrosis requiring total hip replacement in adolescents determine the need for early identification of the causes of hip pain in children engaged in gymnastics. The findings will help improve treatment results and reduce the number of organ replacement interventions.