N 2 (199) 2026. P. 56–61

RADIOGRAPHIC COLLAPSE AS A CRITICAL THRESHOLD IN THE CHOICE BETWEEN TUNNELING AND TOTAL HIP REPLACEMENT: A MULTICENTER ANALYSIS OF TACTICAL DECISIONS

S. O. Varzar, M. L Ankin

Municipal Clinical Hospital No. 11, Odesa, Ukraine
Shupyk National Healthcare University of Ukraine, Kyiv, Ukraine

DOI 10.32782/2226-2008-2026-2-8

Background. Avascular necrosis (AVN) of the femoral head is a therapeutic dilemma between joint-preserving procedures (tunneling) and total hip replacement (THR). Lack of clear radiological thresholds complicates surgical choice and delays prosthesis timing.

Objective: To assess whether the degree of radiographic subchondral collapse can guide surgical strategy in femoral head AVN.

Methods. A multicenter cohort study (2020–2025) analyzed 126 AVN cases in Odesa and Kyiv. Patients were assigned to tunneling (n = 51) or THR (n = 75). Subchondral collapse was measured, with 2 mm as threshold. Outcomes: Harris Hip Score (HHS), Visual Analogue Scale (VAS), revision rates. Logistic regression identified predictors of surgical choice.

Results. Collapse > 2 mm strongly correlated with THR (85.3%), while < 2 mm favored tunneling (78.4%). The 2 mm cutoff had high predictive value (OR=5.6). Age > 50 and bilateral disease were independent predictors of THR. Both groups improved, but HHS was higher after THR (p < 0.01). Military service and post-COVID steroid use emerged as additional ischemic risk factors.

Conclusions. Subchondral collapse > 2 mm is a clinically relevant threshold favoring THR. Patients < 40 years with minimal collapse and unilateral AVN are best suited for joint-preserving options, including potential MSC therapy. Integration of the 2 mm criterion into surgical algorithms may optimize timing and support predictive precision-medicine models.

Keywords: avascular necrosis, femoral head, radiographic collapse, surgical strategy.

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