Treatment of Non-septic Femoral Head Necrosis with a Vascularized Iliac Crest Graft

Cano-Luis, P.; Ricón-Recarey, F.J.; Fuentes-Díaz, A.; Lisón-Torres, A.

doi:10.1016/S1988-8856(07)70024-X

Article information

Abstract

Bibliography

Download PDF

Statistics

Introduction

We present our experience of the treatment of aseptic femoral head necrosis with a vascularized iliac crest graft. This was a retrospective study of 25 hips (22 patients) operated in our hospital between June 1993 and September 2002.

Materials and methods

There was a majority of men, 20 cases; and the left side was most frequently affected. The main predisposing factor was alcoholism, 8 cases. No predisposing factor was found in 5 cases. All the patients were assessed clinically according to the Harris scale and by X-rays according to the modified Ficat-Arlet staging system to determine necrosis progression. The mean follow-up was 4 years.

Results

Mean functional assessment was 87 points. Results were: excellent and good, 76%; fair and poor, 24%. Some degree of deterioration was detected on X-ray in 40% of the hips with a mean of 5.2 years. According to radiological assessment criteria satisfactory evolution was seen in 66%.

Conclusion

Our results are comparable to those seen in the literature. No progression of necrosis was seen on X-rays in 60% of the patients operated.

Key words:

femoral head necrosis

bone transplant

neovascularization

iliac

Introducción

Presentamos nuestra experiencia en el tratamiento de la necrosis aséptica de la cabeza femoral con el injerto vascularizado de cresta ilíaca mediante el análisis retrospectivo de 25 caderas (22 pacientes) intervenidas en nuestro hospital entre junio de 1993 y septiembre de 2002.

Material y método

Predominio de hombres con 20 casos y del lado izquierdo. El factor predisponente más numeroso fue el abuso del alcohol en 8 casos. No se encontró en 5 casos. Todos los pacientes fueron evaluados clínicamente según la escala de Harris y radiológicamente se valoró la progresión de la necrosis según la clasificación de Ficat y Arlet modificada por la ARCO con un seguimiento medio de 4 años.

Resultados

La valoración funcional media fue de 87 puntos con un 76% de excelentes y buenos resultados y un 24% de regulares y malos resultados. El 40% de las caderas sufrió algún tipo de deterioro radiológico con una media de 5,2 años. Según los criterios de valoración radiológica, el 66% evolucionó satisfactoriamente.

Conclusión

Nuestros resultados están en la línea de los publicados en la literatura sin evidenciarse la progresión radiológica de la necrosis en el 60% de los pacientes intervenidos.

Palabras clave:

necrosis de la cabeza femoral

trasplante de hueso

neovascularización

ilíaca

Full text is only aviable in PDF

References

[1.]

J.F. Camp, C.W. Colwell Jr..

Core decompression of the femoral head for osteonecrosis.

J. Bone Joint Surg Am, 68 (1986), pp. 1313-1319

Medline

[2.]

J.H. Simmonet, J.M. Aubaniac, F. Vedel, P. Groulier.

L’osteotomie intertrocantherienne de flexion dans les osteonécroses aseptiques de la tête femorale de l’adulte. A propos de 50 cas.

Rev Chir Orthop, 70 (1984), pp. 219-229

Medline

[3.]

J.R. Valenti, J.R. Azcárate, J.L. Imizcoz, C. Berchkholtz, J. Cañadell.

Nuestra experiencia en el tratamiento de la necrosis isquémica idiopática de la cabeza femoral.

Rev Ortop Traum, 30 IB (1986), pp. 681-688

[4.]

Y. Sugioka.

Transtrochanteric anterior rotational osteotomy of the femoral head in the treatment of osteonecrosis affecting the hip: A new osteotomy operation.

Clin Orthop, (1978), pp. 191-201

Medline

[5.]

I. Kempf, C. Karger, J. Abikhalil, J.F. Kempf.

Posterior rotation osteotomy of the femoral head in femur head necrosis.

Rev Chir Orthop, 70 (1984), pp. 271-282

Medline

[6.]

D.B. Phemister.

Treatment of the necrotic head of the femur in adults.

J Bone Joint Surg Am, 31 (1949), pp. 55-66

[7.]

Mont, G. Etienne, P.S. Ragland.

Outcome of nonvascularized bone grafting for osteonecrosis of the femoral head.

Clin Orthop, (2003), pp. 84-92

[8.]

Cano P. Necrosis aséptica de la cabeza femoral: estudio experimental en base al mecanismo patogénico y al tratamiento con injertos pediculados osteomusculares. (Tesis Doctoral). Sevilla: Universidad de Sevilla; 1987.

[9.]

M.H. Meyers.

The treatment of osteonecrosis of the hip with fresh osteochondral allografts and with the muscle pedicle graft technique.

Clin Orthop, (1978), pp. 202-209

Medline

[10.]

H. Stein, G. Volpin, D. Horer.

Vascularized muscle pedicle flap for osteonecrosis of the femoral head.

Orthopedics, 25 (2002), pp. 485-488

Medline

[11.]

H. Judet, A. Gilbert.

Long-term results of free vascularized fibular grafting for femoral head necrosis.

Clin Orthop, (2001), pp. 114-119

Medline

[12.]

P.N. Soucacos, A.E. Beris, K. Malizos, A. Koropilias, H. Zalavras, Z. Dailiana.

Treatment of avascular necrosis of the femoral head with vascularized fibular transplant.

Clin Orthop, (2001), pp. 120-130

Medline

[13.]

K.N. Malizos, P.N. Soucacos, A.E. Beris.

Osteonecrosis of the femoral head. Hip salvaging with implantation of a vascularizad fibular graft.

Clin Orthop, (1995), pp. 67-75

[14.]

J.R. Urbaniak, P.G. Coogan, E.B. Gunneson, J.A. Nunley.

Treatment of osteonecrosis of the femoral head with free vascularized fibular gafting. A long’term follow-up study of one hundred and three hips.

J Bone Joint Surg Am, 77 (1995), pp. 681-694

Medline

[15.]

P.C. Leung.

Femoral head reconstruction and revascularization: Treatment for ischemic necrosis.

Clin Orthop, (1996), pp. 139-145

http://dx.doi.org/10.1097/01.blo.0000092968.12414.a8 | Medline

[16.]

S. Hasegawa, H. Iwata, S. Torii, T. Iwase, K. Kawamoto, S. Iwasada.

Vascularized pedicle bone-grafting for nontraumatic avascular necrosis of the femoral head.

Arch Orthop Trauma Surg, 116 (1997), pp. 251-258

Medline

[17.]

G. Schwetlick, U. Weber.

Der gefabgestielte mediale becken-kammspan als transplantat bei der hüftkopfnekrose und schenkelhalspsudarthrose des erwachsenen.

Oper Orthop Traumatol, 5 (1993), pp. 171-182

[18.]

G. Schwetlick, U. Weber, J. Hofman, V. Klingmuller.

Preliminary results of treatment with vascular pedicled iliac bone chip in femur head necrosis.

Z Orthop Ihre Grenzgeb, 130 (1992), pp. 129-135

http://dx.doi.org/10.1055/s-2008-1040126 | Medline

[19.]

M. Ishizaka, M. Sofue, Y. Dohmae, N. Endo, H.E. Takahashi.

Vascularized iliac bone graft for avascular necrosis of the femoral head.

Clin Orthop, (1997), pp. 140-148

http://dx.doi.org/10.1097/BLO.0b013e3181468930 | Medline

[20.]

A. Eisenschenk, M. Lautenbach, G. Schwetlick, U. Weber.

Treatment of femoral head necrosis with vascularized iliac crest transplants.

Clin Orthop, (2001), pp. 100-105

[21.]

R.P. Ficat.

Aseptic necrosis of the femur head. Preliminary remarks concerning staging: stage 0.

Acta Orthop Belg, 47 (1981), pp. 239-241

Medline

[22.]

J. González del Pino, F. Gómez-Castresana, E. Galindo-Andújar, E.C. Rodríguez-Merchán.

La necrosis isquémica de la cabeza femoral.

1.a ed., Editorial Garsi S.A., (1988),

[23.]

P.C. Leung, Y.D. Gu, Y. Ikuta, A. Narakas, A. Landi, A.J. Weiland.

Microsurgery in orthopedic practice.

1st ed., World Scientific Publishing Co. Pte. Ltd., (1995),

[24.]

W.H. Harris.

Traumatic arthritis of the hip after dislocation and acetabular fractures: Treatment by mold arthroplasty. And end result study using a new method of result evaluation.

J Bone Joint Surg Am, 51 (1969), pp. 737-755

Medline

[25.]

M.A. Mont, D.S. Hungerford.

Non-traumatic avascular necrosis of the femoral head.

J Bone Joint Surg Am, 77 (1995), pp. 459-474

Medline

[26.]

R. Ganz, R.P. Jacob.

Segmental avascular necrosis of the femoral head: Flexion osteotomy combined with cancellous bone grafting of the lesion.

Orthopade, 9 (1980), pp. 265-277

Medline