Use of vascularized pedicle iliac bone graft in the treatment of avascularnecrosis of the femoral head

A vascularized pedicle iliac bone graft was performed in patients with exte nsive necrosis in whom the necrotic area occupied more than two-thirds of t he femoral head. The purpose of this procedure is to supply vascularity and mechanical strength to the avascular femoral head. Our series consisted of 18 hips. The patients' age at surgery ranged from 21 to 55 years. Fourteen hips were identified as stage II and 4 hips as stage III. Iliac bone graft alone was performed in 4 stage II joints. Transtrochanteric anterior rotat ional osteotomy of the femoral head was done additionally in 10 stage II jo ints and 4 stage III joints. In the group who underwent iliac bone graft al one, the mean Japanese Orthopedic Association (JOA) score improved from 58. 5 to 63.8 (mean follow-up 52 months). In the group who underwent combinatio n procedure with osteotomy, the mean JOA score improved from 71.7 to 85.0 ( mean follow-up 43 months). Stage progression was noted in 3 of 4 joints in the group who underwent iliac bone graft alone. In the group who underwent the combined procedure, stage progression was noted in 2 of 10 joints at mo re than 1 year after operation. A vascularized pedicle iliac bone graft to treat avascular necrosis of the femoral head is considered promising for jo int preservation.