LONG-TERM RESULTS OF JOINT PRESERVING THERAPY OF OSTEONECROSIS OF THEFEMORAL-HEAD WITH A VASCULAR PEDICLED ILIAC BONE-GRAFT

Various therapeutic options have been proposed in the treatment of fem oral head necrosis ranging from conservative management to total hip a rthroplasty. Since microsurgical techniques are routinely used in orth opaedic surgery, the importance of revascularization has increased in recent years. Vascularized bone grafting as well as various osteotomie s have been considered for the stages II and III according to Ficat an d II, III and IV of the criteria of the ARCO system respectively, whic h also bases on MRI-findings. We investigated the results of 80 patien ts with avascular necrosis of the femoral head treated with a vascular pedicled iliac bone graft, perfused by the A. circumflexa ilium profu nda, between 1988 and 1996. Mean follow-up was 5,6 years. The evaluati on was based on the harris hip score, clinical and radiological examin ation as well as a subjective assessment using a VAS (visual analog sc ale). The clinical results according to the harris hip score were good or excellent in 86,1 %. These results correlate with the subjective a ssessment of pain and of the hip joint function with an average of 7,9 points using the VAS (max. 10 points). Unchanged radiological appeara nce over the follow-up period was observed in 47,5 % using the ARCO cr iterias. Reviewing the studies using vascularized grafts, about 50 % o f the patients with a stage II and III according to Ficat and II, ill and IV of the ARCO respectively show an unchanged stage of the disease 5-6 years after the procedure. Therefore, transplantation of a vascul ar pedicled iliac bone graft possibly offers the chance to intervene c ausally in the course of the disease with only little alteration of th e biomechanics of the hip joint.