Treatment of avascular necrosis of femoral head with debridement of necrotic lesion throughout femoral neck and defect recon- struction with autologous bone grafting

Introduction. The aim of the study was a long-term follow-up retrospective examination of operative treatment of avascular necrosis of femoral head consisted of necrotic lesion removal through window made in head-neck junction, and bone loss reconstruction with morselized autografts. Material and methods. In the years 1990-2004 4 men were treated because of avascular necrosis of femoral head. Average age during operation was 27 years (range from 14 to 35 years). All hips had II stage of necrotic changes involvement according to Ficat and Arlet classification. All patients were operated on with anterior approach to hip joint, necrotic lesion debridement through window made in head-neck junction and bone loss reconstruction with autografts taken from iliac crest. Results. The follow-up is from 4 to 15 years (average 10 years). Harris hip score increased from average preoperative 49 points to average 75 points at the longest term examination. Collapse of three femoral heads occurred after average 8 years after the operation. Total hip arthroplasty was performed in two hips because of secondary arthritic changes. One patient has good clinical and radiological result. Conclusions. Bone grafting of the femoral head is a time buying procedure with native hip joint preservation and decreasing symptoms. Operation does not exclude hip joint for subsequent conversion to total hip replacement.