Femoral Osteotomy and Iliac Graft Vascularization for Femoral Head Osteonecrosis

The objective of this study was to determine the long-term clinical and radiologic outcomes of patients with osteonecrosis treated by a combination of intertrochanteric osteotomy and pedicled iliac bone block transfer. Between 1978 and 1986, 41 patients (52 hips) with a mean age of 33 years were operated on for Ficat Stages II and III disease. Thirty-three patients (44 hips) were assessed clinically and radiologically at a mean followup of 13.5 years (range, 5–20 years). Fifteen hips (15 of 44; 34%; 13 patients) had conversion surgery to a total hip arthroplasty because of progressive arthritis or collapse, or both. Six patients died and two were lost to followup. Preoperatively, the patients with failed revascularization had significantly more pain and decreased gait function than patients without failure. In the patients without failure, postoperative pain sensation and gait function improved significantly. However, flexion became restricted mainly because of progressive degeneration of the hip. Radiographically, 31% of the hips (nine hips; six patients) had severe arthritis, 59% (17 hips; 12 patients) had moderate arthritis, and only three hips (two patients) had mild arthritis. Ninety percent of patients without hip failures (26 of 29 hips; 18 patients) considered the functional outcome, including pain relief and gait function, to be successful. Despite the subjective success, this surgery could not restore normal hip anatomy, and arthritis progressed with time. Intertrochanteric osteotomy and vascularized iliac bone block transfer should be considered only in young symptomatic patients with good preoperative clinical function and Ficat Stage II disease.