BONE GRAFTING FOR THE TREATMENT OF OSTEONECROSIS OF THE FEMORAL HEAD
Andrzej Bednarek, M.D.
Lubin, Poland

The key goal in orthopaedic management of femoral head osteonecrosis is to avoid progression to collapse. The results of treatment of advanced stages (ARCO 2 and 3) with moderate or severe collapse are poor. In these stages, the goal of treatment is to preserve sphericity and mechanical properties of the femoral dome. Biological procedure to prevent collapse are excision of lesion and then fill the cavity with impacted bone grafts (auto and allo). Bone grafting through the major trochanter were described by Steinberg and Gardniers.

Since 1996, 38 young patients (41 hips) in Stage 2, 3 and even Stage 4 have been operated upon. There were 30 males and 8 females with average age of 35 years (23-62). The average follow up is 2 and 5 years (1-6).

At the time of the follow up, 28 hips (56%) were completely free of complaints with saved spherical shape of femoral head. Eleven hips (26.8%) had important limitation of ROM and on xray no spherical shape of head, but not significant pain during walking. Seven hips (17%) required THR after 1,5 year.