VASCULARIZED ILIAC PERIOSTEAL TRANSFER FOR THE TREATMENT OF AVASCULARNECROSIS OF THE FEMORAL-HEAD AND A NEW EVALUATION GRADING SYSTEM

Objective. To introduce the surgical technique and a new evaluation gr ading system and to report the results of the vascular iliac periostea l grafting for avascular necrosis of the femoral head. Patients and Me thods, From 1983 to 1994, a new technique was used to treat 75 hips of 60 patients with avascular necrosis (AVN) of the femoral head using t he vascular iliac periosteum with deep iliac circumflex artery and vei n pedicle. 52 patients (66 hips) were followed up for 3-11 years and a ll patients were evaluated clinically and roentgenographically accordi ng to the new evaluation grading system for AVN by the Chinese Society for Osteonecrosis. Results. Preoperatively, the average AVN score was 57 pts., and all patients had significant pain and limp. Five hips we re at Ficat/Arlet stage IV, 40 were at stage III, and 21 were at stage II. Postoperatively, the average AVN score was 83 pts., 47 hips were pain free, 13 had mild pain, and 6 had moderate pain. At the latest fo llow-up, according to the new evaluation grading system, 26 hips were graded as excellent, 32 hips as good, 5 hips as fair, and 3 hips as po or. Conclusion. It is one of the better alternatives that can prevent the necrotic femoral head from progressing to collapse and promote rev ascularization and new bone formation by a direct mechanism, and it is suitable for the treatment of AVN of the stage I to III.