The Relationship Between Femoral Head Avascular Necrosis and Erectile Dysfunction: A Retrospective Case-Control Study Based on the Ficat-Arlet Classification and IIEF Score

Background/Objectives: Femoral head avascular necrosis (FAN) is a serious orthopedic disorder that causes the death of bone tissue as an outcome of occlusion or insufficiency of the vessels supplying blood to the femoral head. It is especially common in middle-aged men. Factors such as alcohol consumption, corticosteroid use, trauma, and systemic diseases have influential roles in the development of FAN, and the ensuing vascular disruptions can also negatively affect the patient’s broader systemic vascular health. Erectile dysfunction (ED) is a condition caused by impairment of the penile blood flow, which reduces quality of life in men and has psychosocial effects. This study examined the potential relationship between FAN and ED in consideration of the similar pathophysiological mechanisms of these conditions. Methods: The research was planned as a retrospective case-control study and conducted between January 2020 and December 2023. FAN was diagnosed based on the Ficat-Arlet classification using plain radiography and magnetic resonance imaging, and staging was performed with expert clinical evaluations. The International Index of Erectile Function (IIEF) scale was administered to evaluate ED. Data from 50 patients with FAN and 50 healthy men were evaluated using appropriate statistical methods including the Student t-test, Shapiro-Wilk test, Kruskal-Wallis test, and Dunn and Spearman correlation analysis. Results: The analysis revealed that an increase in FAN stage was associated with a significant increase in ED severity. The prevalence of ED among FAN patients was significantly higher compared to the control group with the Spearman correlation coefficient obtained for FAN stage and IIEF score (r=-0.631; p=0.001) supporting the significant relationship between these two conditions. There was no significant difference between the groups in age distribution. Conclusions: This study demonstrated that with the progression of FAN, systemic vascular deterioration affects penile blood flow, increasing the severity of ED. This finding highlights the common pathophysiological mechanisms of FAN and ED and reveals the importance of early diagnosis and multidisciplinary treatment approaches. This relationship should be examined in detail with larger samples and prospective designs in future studies.