OSTEONECROSIS OF THE FEMORAL-HEAD IN IMMUNOSUPPRESSED PATIENTS - HIP SALVAGING WITH IMPLANTATION OF A VASCULARIZED FIBULAR GRAFT

Osteonecrosis frequently occurs in patients being treated with steroid s for conditions such as systemic lupus erythematosus and other collag en diseases and in renal transplant recipients. It remains an unsolved problem and can cause more disability than the underlying disease, pa rticularly in young patients. In a series of eight young patients who received continuous corticosteroids and immunosuppressive agents, we a ttempted hip salvage in ten joints by implantation of a vascularised f ibular graft into the necrotic femoral head. Follow-up ranged from 18 to 36 months. Joints which were operated on prior to articular surface collapse had complete restoration of normal function. In patients wit h more advanced lesions, surgery resulted in a painless hip, improved range of motion, and cessation of further progress of the disease. The preliminary data are considered encouraging enough to suggest that th e vascularised fibular graft is an appropriate method for hip salvage in immunosuppressed patients with osteonecrosis of the femoral head. ( C) 1994 Wiley-Liss, Inc.