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 cli nical 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 approa ch. A window was then made in the femur at the head/neck junction. Dri lls, burrs and curettes were utilized under image intensification to p erform a thorough debridement of all sclerotic bone. Cancellous bone w as harvested from the ipsilateral iliac crest and was packed tightly i nto the femoral head to the subchondral plate. The cortical window was replaced. In 3 patients a gluteus medius pedicle flap was also utiliz ed to augment the blood supply to the bone graft. This approach provid ed the access necessary to debride all dead and sclerotic bone. Healin g and support of the subchondral plate were subsequently augmented wit h tightly packed cancellous bone graft. The patients were followed for 10-15 years (mean, 12 years). Two (13%) have since gone on to revisio n with total hip arthroplasty. The others (87%) remain essentially sym ptom free with minimal progression of osteoarthritis. There were no in fections, femoral neck fractures, or thromboembolic events. Two patien ts with gluteal pedicle flaps developed ectopic calcification. Thoroug h debridement and cancellous bone grafting in patients with avascular necrosis of the femoral head is an effective procedure in young patien ts with Stage II or Stage III disease that will delay, if not prevent, the progression of osteoarthrosis and subsequent total hip arthroplas ty.