Avascular necrosis of the acetabulum is uncommon. It is not frequently considered when problems occur after hip joint surgery and it may go undetected on imaging studies.
Risk factors for avascular necrosis of the acetabulum:
(1) severe peripheral arterial disease with poor collateral circulation
(2) traumatic or surgical damage to the acetabular blood supply
Avascular necrosis of the acetabulum should be considered when there is:
(1) deep surgical site infection of a hip arthroplasty that is resistant to therapy or that is recurrent
(2) there is unexplained failure of the acetabular component (loosening and migration)
(3) fracture of the acetabulum that was repaired via an extensile anterior ilio-inguinal approach
Angiography to determine the vascular supply should be considered prior to revision of failed acetabular fixation.
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