Bone grafting for osteonecrosis of the femoral head

There has been a recent explosion of information relating to the etiology, pathophysiology, and treatment of avascular necrosis, or osteonecrosis, of the femoral head; however, few definitive conclusions have been made regarding either its development or treatment. Because of its tendency to progress to femoral head collapse and subsequent hip degeneration, and its propensity to afflict younger patients, osteonecrosis continues to serve as the subject of considerable debate and research. Conceptually, the ideal operation for this problem would be one which removes the necrotic bone from the femoral head, replacing it with viable and structurally sound bone, thus restoring vitality to the femoral head, and preventing collapse of the articular surface. To date, there is no consensual agreement among surgeons as to a single reliable surgical procedure which can consistently achieve these aforementioned objectives. Several treatment options for osteonecrosis of the femoral head have been described, including weight restriction and observation, core decompression, osteotomies, bone grafting (structural or nonstructural and vascularized or non-vascularized), and arthroplasty (hemiarthroplasty, resurfacing techniques, and total hip replacements). Bone grafting is an attractive treatment option in that it combines the benefit of decompressing the femoral head with the added benefit of introducing an osteoconductive and/or osteoinductive material into the devitalized head. Furthermore, such grafting preserves the natural hip geometry and articular cartilage, unlike the osteotomy and arthroplasty techniques described. We present a comprehensive list of the various and current bone grafting techniques for osteonecrosis of the femoral head. © 2004 Elsevier Inc. All rights reserved.

Duke Scholars

Author James Randolph Urbaniak Orthopaedic Surgery