Abstract
Introduction
A vascularized pedicle iliac bone graft combined with transtrochanteric anterior rotational osteotomy was performed in patients with extensive necrosis in whom the necrotic area occupied more than two-thirds of the weight-bearing zone of the femoral head. The purpose of this procedure is to supply vascularity and mechanical strength to the avascular femoral head.
Materials and methods
Seventeen hips in 14 patients (8 male, 6 female) whose average age at surgery was 37.9 (range 21–51) years underwent this procedure between June 1992 and December 2002. These hips (stage 2 in 3 hips, stage 3A in 13 hips, and stage 3B in 1 hip) were examined for changes according to the Japanese Orthopedic Association (JOA ) score and the presence or absence of progression of the clinical stage at least 1 year after surgery.
Results
The mean JOA score improved from 67.8 points preoperatively to 78.1 points by 18–133 (mean 50.7) months postoperatively. There was no disease progression to a more advanced stage in 12 of 17 hips (71%) postoperatively.
Conclusion
A vascularized pedicle iliac bone graft combined with transtrochanteric anterior rotational osteotomy to treat avascular necrosis of the femoral head is considered promising for joint preservation.
Similar content being viewed by others
References
Berend KR, Gunneson EE, Urbaniak JR (2003) Free vascularized fibular grafting for the treatment of postcollapse osteonecrosis of the femoral head. J Bone Joint Surg Am 85:987–993
Brunelli G, Brunelli G (1991) Free microvascular fibular transfer for idiopathic femoral head necrosis; long-term follow-up. J Reconstr Microsurg 7:285–295
Ganz R, Buchler U (1983) Overview of attempts to revitalize the dead head in aseptic necrosis of the femoral head-osteotomy and revascularization. In: Hungerford DS (ed) Hip. CV Mosby, New York, pp 296–305
Hasegawa Y, Sakano S, Iwase T, Iwasada S, Torii S, Iwata H (2003) Pedicle bone grafting versus transtrochanteric rotational osteotomy for avascular necrosis of the femoral head. J Bone Joint Surg Br 85:191–198
Ishizaka M, Sofue M, Dohmae Y, Endo N, Takahashi H (1997) Vascularized iliac bone graft for avascular necrosis of the femoral head. Clin Orthop 337:140–148
Iwata H, Torii S, Hasegawa Y, Itoh H, Mizuno M, Genda E, Kataoka Y (1993) Indications and results of vascularized pedicle iliac bone graft in avascular necrosis of the femoral head. Clin Orthop 295:281–288
Leung PC, Chow YYN (1984) Reconstruction of proximal femoral defects with a vascular-pedicled graft. J Bone Joint Surg Br 66:32–37
Leung PC (1987) Use of vascularized pedicle iliac crest graft in treatment of ischemic necrosis of femoral head. In: Urbaniac JR (ed) Microsurgery for major limb reconstruction. CV Mosby, St Louis, pp 200–204
Miyanishi K, Noguchi Y, Yamamoto T, Irisa T, Suenaga E, Jingushi S, Sugioka Y, Iwamoto Y (2000) Prediction of the outcome of transtrochanteric rotational osteotomy for osteonecrosis of the femoral head. J Bone Joint Surg Br 82:512–516
Noguchi M, Kawakami T, Yamamoto H (2001) Use of vascularized pedicle iliac bone graft in treatment of avascular necrosis of femoral head. Arch Orthop Trauma Surg 121:437–442
Sotereanous DG, Plakseychuk AY, Rubash HE (1997) Free vascularized fibula grafting for the treatment of osteonecrosis of the femoral head. Clin Orthop 344:243–256
Sugioka Y (1978) Transtrochanteric anterior rotational osteotomy of the femoral head in the treatment of osteonecrosis affecting the hip. Clin Orthop 130:191–201
Sugioka Y, Hotokebuchi T, Tsutsui H (1992) Transtrochanteric anterior rotational osteotomy for idiopathic and steroid-induced necrosis of the femoral head. Clin Orthop 277:111–120
Urbaniak JR, Coogan PG, Gunneson EB, Nunley JA (1995) Treatment of osteonecrosis of the femoral head with free vascularized fibular grafting. J Bone Joint Surg Am 77:681–694
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Matsusaki, H., Noguchi, M., Kawakami, T. et al. Use of vascularized pedicle iliac bone graft combined with transtrochanteric rotational osteotomy in the treatment of avascular necrosis of the femoral head. Arch Orthop Trauma Surg 125, 95–101 (2005). https://doi.org/10.1007/s00402-004-0777-z
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00402-004-0777-z