Viable Iliac Bone Grafting for Osteonecrosis of the Femoral Head in Young Patients under 40 Years
TR Yoon, SM Rowe, ES Moon, EK Song, KB Lee, HY Seo
Department of Orthopedics, Chonnam National University Hospital, Kwangju, Korea

Introduction: Osteonecrosis of the femoral head remains a challenging problem especially in young patients. The purpose of this study was to evaluate the clinical results of a viable iliac bone graft for treating osteonecrosis of the femoral head.

Patients and Methods: Seventy-one hips in 52 young patients underwent a viable iliac graft (9 hips-vessel pedicle iliac bone graft and 62 hips-muscle pedicle iliac bone graft). The clinical and radiographic results were evaluated after an average of 3 years and 4 months (range 2 to 5 years). Patient age ranged from 20 to 40 years with an average of 31. Twenty-three hips were classified in Ficat stage 2 and 48 in stage 3. The causes of osteonecrosis were excessive alcohol consumption in 30, steroid use in 13, posttraumatic in 4, decompression sickness in 1, and unknown cause in 23 hips. The clinical results were evaluated depending on the patients' satisfaction and pain score. The radiographical results were evaluated by a serial follow up of roentgenography and pinhole bone scintigraphy.

Results: The clinical and radiological results were satisfactory. Overall, the survival rate was 96 percent. Excellent results were obtained in 15 hips, good in 39, fair in 6 and poor in 8. Three hips underwent total hip replacement, including one infected case. Excellent or good results were obtained in 82 percent of stage 2 cases and in 65 percent of stage 3 cases. The serial roentgenographic examination revealed a gradual incorporation of the grafted bone, and the scintigraphic examination a gradual increase in the uptake which suggested increased blood supply to the femoral head.

Discussion and Conclusion: The overall results of viable iliac bone grafting were very satisfactory. This technique is recommended particularly for young patients with stage 2 or 3 osteonecrosis of the femoral head. Pinhole bone scintigraphy was quite useful for evaluating the healing process after the revascularization procedure.