Non-Traumatic Necrosis of the Femoral Head

Osteonecrosis during the treatment of childhood acute lymphoblastic leukemia: A prospective MRI study

“…Our study yielded new information about the clinical course of osteonecrosis. It has been generally believed that spontaneous regression or healing of osteonecrosis is extremely rare [31]. We have found few sporadic reports concerning children with steroid-related osteonecrosis with spontaneous resolution [14,32,33].…”

A current review of non-vascularized bone grafting in osteonecrosis of the femoral head

“…It involves removing a 7-to 9-mm-diameter cylindrical core from the femoral head and neck (similar to core decompression), which is then replaced by a cortical graft removed from the tibia, fibula, or ilium. In 1970, Boettcher et al [10] evaluated the clinical and radiographic outcomes of 38 hips with ONFH treated with cortical strut grafting. The authors defined a satisfactory outcome as minimal functional restriction, moderate, minimal, or no pain and a score on the Iowa hip-rating scale of at least 70 points.…”

Osteonecrosis Femoral Head Treatment by Core Decompression and ILIAC CREST-TFL Muscle Pedicle Grafting

“…Boettcher etal. 15 reported success in 27 (71%) of 38 hips 6 years after nonvascularized tibial strut grafting. However, a longer-term evaluation (performed at a mean of 14 years postoperatively) that included the original 38 hips in the study by Boettcher et al found that only 16 (29%) of 56 hips still had a good result.…”

“…Head preserving operation of core decompression and various types of bone grafting certainly gave excellent results in early stage of osteonecrosis. Despite the many reports on the utility of various operative procedures no single method has uniformly demonstrated the arrest of the disease or prevention of collapse of the femoral head 11 The use of nonvascularised tibial (Phemister) or fibular bone graft (Boettcher & Bonfiglio) 15 is useful only in the early stages but in later stages, the results were very poor. Subarticular curettage and cancellous bone grafting failed to relieve pain and prevent progressive collapse of the femoral head.…”