Treatment of Hip Osteonecrosis with Bone Impaction Grafting
JWM Gardeniers¹, WHC Rijnen¹, P Buma¹, K Yamano², TJJH Slooff¹, BW Schreurs^1
1Orthopaedic Department, University Medical Center Nijmegen, Nijmegen, the Netherlands, and ²Showa University, Fujigaoka Hospital, Yokohama, Japan

Even in extensive osteonecrosis of the femoral head, in younger patients a femoral head preserving method is preferable. After a core biopsy and removal of the osteonecrotic area impacted morsellized bone allografts were used to fill the head to regain sphericity, and to prevent a collapse. In this prospective single surgeon study, we included 28 consecutive hips in 27 patients with extensive osteonecrotic lesions (ARCO classification Stage 2 (11 hips), Stage 3 (14 hips) and Stage 4 (three hips), 14 hips had preoperative collapse. The mean age of the patients was 33 years (range, 15-55 years). At a mean followup of 42 months (range, 24-119 months) eight hips (29%) were converted to a total hip arthroplasty. Of the 20 reconstructions that were in situ, 18 were clinically successful (90%) and 70% were radiologic successful. Patients who were younger than 30 years at surgery had a radiologic significant better outcome, even those with higher stages of osteonecrosis. Patients with preoperative collapse and use of corticosteroids had disappointing results. This method is attractive as a salvage procedure, is relatively simple and quick, and it does not intervene with an eventual future hip Arthroplasty.