Treatment of Non-septic Femoral Head Necrosis with a Vascularized Iliac Crest Graft | Revista Española de Cirugía Ortopédica y Traumatología (English Edition)

Article information

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

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