Will a vascularized greater trochanter graft preserve the necrotic femoral head?

Various head-preserving procedures have been used for young patients with osteonecrosis of the femoral head (ONFH) to avert the need for THA. However, none of these techniques are accepted universally because of the technical difficulties, complications, or mixed results that often are difficult to reproduce.

We describe a technique using vascularized bone grafting for treating ONFH in Stages II-IV (Ficat and Arlet) disease, describe our indications, and report the survival of this technique and the functional scores.

We retrospectively reviewed 191 patients (195 hips) who underwent vascularized greater trochanter grafting for osteonecrosis of the femoral head (Ficat and Arlet Stages II-IV) from 1995 to 2006. The mean age of the patients was 44 years (range, 19-59 years). The minimum followup was 2 years (mean, 8 years; range, 2-11 years).

Twenty patients (23 hips) had conversion surgery to THA. The mean Harris hip scores for the patients who did not have conversion surgery to THA improved from 53 to 88 points. Kaplan-Meier survival analysis showed no difference in the 11-year survival rate between patients with Stage II and Stage III disease (THA as an end point). However, the survival rate was lower for patients with Stage IV disease compared with patients with Stages II and III disease. The survival rate for patients in the steroid group was lower compared with the rates for patients in the idiopathic, alcoholic, trauma, and hyperlipidemia groups. At last followup, the stage of necrosis remained unchanged in 118 hips.

We believe vascularized greater trochanter bone grafting is appropriate for young selected patients with mild to moderate collapse of the femoral head.

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.