OUTCOME OF NONVASCULARIZED BONE GRAFTING FOR OSTEONECROSIS OF THE FEMORAL HEAD
Mont M, Jones LC, Rajadhyaksha A, Etienne G

Introduction: Various treatment modalities are being used for the management of osteonecrosis of the femoral head in order to prevent or delay the need for total hip arthroplasty. This report reviews our results of nonvascularized bone grafting through a window at the femoral head-neck junction.

Methods: Nineteen patients (20 hips) were followed for a mean of 31.4 months (range 25 to 40 months) after a nonvascularized bone grafting procedure in which diseased bone was replaced with a bone graft substitute (combination of demineralized bone matrix, processed allograft bone chips, and a thermoplastic carrier matrix). Seven Ficat Stage II and thirteen Stage III hips were enrolled in the study. Clinical success was defined as a Harris Hip Score greater than 80 points and radiographic success included evidence of graft healing and no head collapse.

Results: Seventeen out of twenty hips (85%) were clinically successful at 31.4 months (range, 25 to 40 months). Three patients required revision: one for a femoral neck fracture two weeks postoperatively, possibly, because of non-compliance with weight bearing instructions, the second and third were revised at a mean of 25 months for persistent groin pain. Of the seventeen clinical successes, two have shown minimal radiographic progression of disease (less than two millimeter collapse).

Discussion: This bone grafting procedure may be effective in avoiding or delaying the need for total hip arthroplasty in patients with osteonecrosis. 228