Acta chirurgiae orthopaedicae
et traumatologiae Čechoslovaca

Acta Chir Orthop Traumatol Cech. 2026; 93(3):162-169 | DOI: 10.55095/achot2026/015

Avascular Necrosis of the Femoral Head after Hodgkin Lymphoma Treatment: Analysis of Risk Factors and Mid-Term Outcomes after Total Hip Replacement

MARTIN SALÁŠEK^{1, 2}, JANA MARKOVÁ³, KAROLÍNA BAREŠOVÁ⁴, RICHARD ČESKÝ⁵, HEIDI MÓCIKOVÁ³, MICHAL ZÍDKA^{6, 7}, VALÉR DŽUPA⁷

¹ Department of Orthopaedics and Traumatology, Faculty of Medicine of Charles University, and University Hospital, Pilsen

² New Technologies for the Information Society, Faculty of Applied Sciences of University of West Bohemia, Pilsen

³ Department of Hematology, Third Faculty of Medicine of Charles University, and University Hospital Královské Vinohrady, Prague

⁴ Department of Neurology, Faculty of Medicine and Dentistry of Palacky University, and University Hospital, Olomouc

⁵ Department of Orthopaedics, Hospital České Budějovice, České Budějovice

⁶ Musculoskeletal System Treatment Center, Prague

⁷ Department of Orthopaedics and Traumatology, Third Faculty of Medicine of Charles University, and University Hospital Královské Vinohrady, Prague

Treatment of classical Hodgkin lymphoma (cHL) can be eventually complicated by avascular necrosis of the femoral head (AVN FH). Stages 1 and 2 of AVN FH can be treated conservatively, but stages 3 and 4 are indicated for surgery. In adults, total hip replacement (THR) is the preferred method. The goal of our study was to analyze the risk factors for AVN FH and functional results after THR.



This is a single-center retrospective observational longitudinal study. Patients with AVN FH after previous cHL treatment were included. Basic epidemiological data, time to AVN FH and THR, and complications of hemato-oncological treatment and THRs were recorded. Risk ratios, derived from 2×2 tables and from univariate Cox regression and Kaplan-Meier graphs, were analyzed. Categorical data were evaluated using the Fisher exact test and quantitative data using the Mann-Whitney-Wilcoxon test. Outcomes were measured using the modified Harris Hip Score (MHHS).



The mean incidence of AVN HF was 1.7 per year (95% CI 1.1-2.2). Patients with THRs tended to be older (p = 0.0424), the highest risk was ≥ 50 years. Mixed cellularity (MC) cHL had a higher risk of THR (log-rank test p = 0.0249) compared to nodular sclerosis (NS) cHL. Clinical stage IIB with massive mediastinal tumor was associated with the lowest risk of THR, p = 0.0348. The mean modified Harris Hip Score (MHHS) was higher in NS compared to MC subtype (85.1 (82.7-87.6) vs. only 75.4 (66.6-84.2), p = 0.0311).

Periarticular calcification grade 1 was diagnosed in 84.6% of patients (95% CI 54.6-98.1). Revision surgery with cup and stem replantation was performed in one patient. No infections or cases of deep venous thrombosis were recorded.

THR is a causal treatment of symptomatic AVN FH following cHL treatment. Age ≥ 50 years, MC subtype cHL, and AVN FH stages 3 and 4 were associated with a higher risk of THR. The mean MHHS was fully comparable with THRs for other indications. Higher calcification rates had no impact on the clinical outcome.

Received: March 8, 2026; Revised: March 8, 2026; Accepted: April 7, 2026; Published: July 1, 2026  Show citation