Vascular pedicled iliac bone grafting is effective in patients with an early stage of femoral head avascular necrosis
Nurzat Elmalı1, Kadir Ertem1, Mustafa Karakaplan1, Demet Pepele2, Cihat Dağgez1, Haldun Topgül1
1Department of Orthopedics and Traumatology, Medical Faculty of İnönü University, Turgut Özal Medical Center, Malatya, Turkey
2Department of Orthopedics and Traumatology, Adıyaman State Hospital, Adıyaman, Turkey
Keywords: Avascular necrosis; femoral head; vascularized iliac graft.
Objectives: This study aims to evaluate clinical and radiological findings of a series of patients with avascular necrosis of the femur head (ANFH) treated by core decompression and vascular pedicled iliac crest grafting.
Patients and methods: This retrospective study included 26 hips of 22 patients (14 males, 8 females; mean age 36 years; range 16 to 48 years) with ANFH using the vascularized iliac bone grafting between March 2003 and July 2010 in our clinic. The main predisposing factor was steroid use in 13 patients. All patients were assessed clinically according to the Harris hip score and by radiographs by the Association Internationale de Recherche sur la Circulation Osseuse (ARCO) staging system.
Results: The mean follow-up was 36 (range 14 to 62) months. Eleven hips (42%) had stage II and 15 hips (58%) had stage III ANFH. The mean Harris scores increased from 52 (range 31 to 63) to 82.8 (range 62 to 90) after surgery. Based on clinical outcomes, 18 hips (69%) were presented as excellent and good, while eight hips presented fair and poor. According to the ARCO staging system, satisfactory results were provided in 17 (65%) of the 26 hips. Two of four hips at preoperatively stage II progressed to stage III, two other hips to stage IV. Five hips at stage III preoperatively progressed to stage IV and these hips had to undergo hip replacement.
Conclusion: Our results suggest that core decompression and the vascular pedicled iliac bone grafting are effective in early stages of ANFH.