Iliac graft vascularization for femoral head osteonecrosis

We determined the long-term clinical and radiologic outcomes of patients with osteonecrosis treated with a combination of autologous cancellous bone impaction and pedicled iliac bone block transfer perfused by the ascending branch of the lateral femoral circumflex artery. We retrospectively reviewed 197 patients (226 hips) operated on from 1985-1998 who had a mean age of 38 years (range, 19-65 years) and an average followup of 12.5 years (range, 6-19 years). Fourteen hips (13 patients) (6%) had conversion to a total hip arthroplasty because of progressive collapse, severe pain, or both. Of the remaining 212 reconstructions, 195 hips were clinically successful (92%), and 76% were radiographically successful. The postoperative Harris hip score substantially improved in the patients without hip failure. Successful results were achieved in 96% of the patients with Ficat and Arlet Stage II osteonecrosis, 90% with Stage III osteonecrosis, and 57% with Stage IV osteonecrosis. Good results were obtained in 94% of the patients younger than 45 years. Our data suggest the method is useful for treating osteonecrosis of the femoral head only in active symptomatic patients with good integrity of hip cartilage and Stages II or III osteonecrosis.

Therapeutic study, Level IV (case series). See the Guidelines for Authors for a complete description of levels of evidence.