Muscle-pedicle bone graft and cancellous bone graft for the "silent hip" of idiopathic ischemic necrosis of the femoral head in adults.

Ten adult patients with the "silent hip lesion" of idiopathic ischemic necrosis of the femoral head were treated by the muscle-pedicle bone and cancellous bone graft procedure. They were followed postoperatively for 24 to 61 months (mean 42.4 months). Seven patients have remained asymptomatic, showing progressive healing of the hip lesions. Three patients were found to have failure as observed by collapsed femoral head or appearance of "crescent sign" in roentgenograms. Histologic sections of a collapsed femoral head revealed satisfactory incorporation of grafts into the surrounding bone of the femoral head and replacement of osteonecrotic bone extending from the muscle-pedicle graft to subchondral plate. The surgical procedure consisting of curettage of necrotic bone with a cancellous bone and muscle-pedicle bone graft can provide good results for Stages 1 and 2 of the idiopathic ischemic necrosis for an average follow-up of 3 1/2 years.