Vascularized pedicle bone-grafting for nontraumatic avascular necrosis of the femoral head A 5- to 11-year follow-up

Abstract

We investigated the results of 31 hips in 26 patients with nontraumatic (n = 20) and steroid-induced (n = 6) avascular necrosis of the femoral head (ANFH) treated with vascularized iliac pedicle bone graft (PBG). The average age at operation was 38.3 years. Three were women and 23 men. The average follow-up was 8.0 years. The Harris hip score prior to operation and at latest follow-up improved from 62 to 83; one hip collapsed and was revised with a bipolar endoprosthesis. At the final follow-up, 19 hips (63%) were clinically rated as good to excellent, 4 fair, and 7 poor. At the final follow-up, 15 of 27 hips (56%) of stage II before operation showed progressive collapse after bone grafting. In steroid-induced ANFH, in three women, 2 of 4 hips showed poor results. These results are only slightly better than those of core decompression and no better than those obtained after decompression and simple nonvascularized grafts to provide support for the subchondral bone. We concluded that vascularized PBG is sometimes indicated for ANFH in an early stage before collapse of the femoral head.

Will a Vascularized Greater Trochanter Graft Preserve the Necrotic Femoral Head?

“…High failure rates (2.3%-24.1% at a minimum of 4 years' followup) have been reported in this group of patients who underwent THA [4,[7][8][9]21]. Therefore, we believe the initial goal of treating ONFH should be to preserve the femoral head [18,29,44,52].…”

Systematic Analysis of Classification Systems for Osteonecrosis of the Femoral Head

“…Because these patients are young and relatively active, and because total hip arthroplasty has not always been associated with an optimal outcome in this patient population, various procedures for joint preservation have been utilized, ranging from core decompression [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] , percutaneous drilling 17 , vascularized and nonvascularized bone-grafting [21][22][23][24][25][26][27][28][29][30][31] and osteotomies [32][33][34][35][36][37][38] to hemiresurfacing [39][40][41][42] , total hip arthroplasty 1,3 , and metal-on-metal total hip resurfacing 43,44 . Unfortunately, these methods have different indications and various reported success rates and there is tremendous controversy concerning when to use the various procedures 45 .…”

Treatment of osteonecrosis of the femoral head with vascularized bone grafting

“…While 63 % reported good-excellent results postop, the results were only Bslightly^better than core decompression and revealed no significant difference when compared to non-vascularized fibular graft. Of note, the authors also state technical difficulty in removing in entirety the necrotic bone within the femoral head beneath the subchondral bone, and with evaluating and restoring femoral head sphericity, making treatment of advanced lesions difficult [16]. Pavlocic's data supports this conclusion.…”

“…1) [5]. Described methods of bone grafting with vascularized bone include iliac crest and greater trochanteric bone pedicle graft, as well as free vascularized fibular graft [8,9,11,[15][16][17].…”