Treatment of osteonecrosis of the femoral head with core decompression and bone grafting.

Osteonecrosis of the femoral head (ONFH) is a disorder that can lead to femoral head collapse. Various procedures have been advocated to avert the need for total hip replacement. These include vascularised and non-vascularised bone grafting procedures. We examined the effect of core decompression combined with an allogeneic, antigen-extracted, autolysed fibular allograft and autologous impacted bone grafting for the treatment of osteonecrosis of the femoral head. The study included 162 patients (223 hips; 61 females, 101 males; mean age 33.5 years, range 19-54 years) with stage II-III avascular necrosis of the femoral head according to the ARCO (Association Research Circulation Osseous) classification. The outcome was determined by changes in the Harris hip score, by progression in radiographic stages, and by the need for hip replacement. The mean follow-up was 24 months (range 7- 42 months). Statistical evaluation included Kaplan-Meier survival analysis. The mean Harris hip score increased from 61 to 85. Excellent and good results were obtained in 93.3% of cases in stage II, and 87% in stages III with a survivorship of 81% in all cases. Core decompression combined with an allogeneic, antigen-extracted, autolysed fibular allograft and autologous impacted bone grafting may be the treatment of choice, particularly in the precollapse stage.