Treatment of avascular necrosis of the hip by a non-vascularised cortical graft

Abstract

This retrospective study describes the long-term results of core decompression and placement of a non-vascularised bone graft in the management of avascular necrosis of the femoral head. We treated 80 hips in 65 patients, 18 by a cortical tibial autograft and 62 by a fibular allograft. The mean age of the patients was 36 years (SD 13.2). A total of 78 hips were available for evaluation of which pre-operatively six were Ficat-Arlet stage 0, three stage I, 31 stage IIA, 16 stage IIB, 13 stage III and nine stage IV. A total of 34 hips (44%) were revised at a mean of four years (SD 3.8). Survivorship analysis using a clinical end-point showed a survival rate of 59% five years after surgery. We found a significant difference (p = 0.002) in survivorship, when using a clinical and radiological end-point, between the two grafts, in favour of the tibial autograft. We considered this difference to be the result of the better quality and increased volume of tibial bone compared with that from the trochanteric region used with the fibular allograft. This is a relatively simple, extra-articular and reproducible procedure. In our view core decompression, removal of the necrotic tissue and packing of the cancellous grafts into the core track are vital parts of the procedure.

The Vascularized Fibular Graft in Precollapse Osteonecrosis: Is Long-term Hip Preservation Possible?

“…Another technically simpler operation to consider is treatment of ONFH with a nonvascularized cortical graft. Our results compare favorably with results of this technique where survivorship has been reported to be 59% at 5 years [14]. Plakseychuk et al [22] have published the only direct comparison of vascularized versus nonvascularized fibular grafting of ONFH.…”

A current review of core decompression in the treatment of osteonecrosis of the femoral head

“…After a mean follow-up of 24 months (range, 7 to 42 months), they found a hip survival rate (no further surgeries required) of 81 % and a mean Harris Hip Score (HHS) that increased from 61 to 86 points at latest follow-up. Furthermore, multiple studies have shown that this can be an effective method for delaying the need for THA while subsequently allowing core decompression to be effective in later stages of ON [42][43][44][45][46].…”

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

“…Keizer et al [15] evaluated the use of autogenous cancellous bone grafting through a core tract in a cohort of patients who had Ficat stages 1 to 4 ONFH (n=78 hips). After a mean follow-up of 7 years, 34 hips (44 %) required further procedures.…”