LONG-TERM FOLLOW-UP OF THOROUGH DEBRIDEMENT AND CANCELLOUS BONE-GRAFTING OF THE FEMORAL-HEAD FOR AVASCULAR NECROSIS

From 1977 to 1982, 13 patients were diagnosed with avascular necrosis of the femoral head. The diagnoses were made with a combination of clinical exams, radiographs, tomograms, and Tc99 bone scans. One hip was classified as Ficat Stage I, 9 as Stage II, and 5 as Stage III. There were 11 male and 2 female patients with an average age at the time of surgery of 34 years. Idiopathic osteonecrosis was the final diagnosis in 10 patients, while 3 had a significant history of steroid use. The anterior neck was approached via Watson-Jones or Smith-Petersen approach. A window was then made in the femur at the head/neck junction. Drills, burrs and curettes were utilized under image intensification to perform a thorough debridement of all sclerotic bone. Cancellous bone was harvested from the ipsilateral iliac crest and was packed tightly into the femoral head to the subchondral plate. The cortical window was replaced. In 3 patients a gluteus medius pedicle flap was also utilized to augment the blood supply to the bone graft. This approach provided the access necessary to debride all dead and sclerotic bone. Healing and support of the subchondral plate were subsequently augmented with tightly packed cancellous bone graft. The patients were followed for 10-15 years (mean, 12 years). Two (13%) have since gone on to revision with total hip arthroplasty. The others (87%) remain essentially symptom free with minimal progression of osteoarthritis. There were no infections, femoral neck fractures, or thromboembolic events. Two patients with gluteal pedicle flaps developed ectopic calcification. Thorough debridement and cancellous bone grafting in patients with avascular necrosis of the femoral head is an effective procedure in young patients with Stage II or Stage III disease that will delay, if not prevent, the progression of osteoarthrosis and subsequent total hip arthroplasty.