Gefäßgestieltes Beckenkammtransplantat zur Behandlung der Femurkopfnekrose

Abstract

Illustration of anowadays only rarely performed operative procedure for the treatment of osteonecrosis of the femoral head to prevent or at least delay advanced arthrosis and the need for atotal hip replacement. The pedicled vascularized iliac bone graft is raised without the need for special microsurgical techniques and has less vascular complications often seen in free vascularized grafts. Early stages of osteonecrosis of the femoral head stagesII andIII according to the Association Research Circulation Osseous (ARCO) up to the detection of fracture lines (crescent sign) but without mechanical insufficiency. Osteonecrosis of the femoral head with collapse of the femoral head (ARCO stage ≥IIIB) and mechanical insufficiency. Patients who are noncompliant or anot able to take the weight off the operated leg. Patients who had radiotherapy or an operation on ipsilateral inguinal lymph nodes and patients who have vascular anomalies or severe arteriosclerosis. Debridement of the femoral head osteonecrosis and implantation of apedicled vascularized iliac bone graft. Free movement of the hip joint 4weeks after surgery. Outward rotation of the hip joint allowed after 3months and restriction of weight load on the operated leg for at least 3-6months postoperatively depending on the bony consolidation. Vascularized bone grafts for the treatment of femoral head necrosis show better clinical and radiological results than avascular bone grafts. Nevertheless, after 5years follow-up approximately 25% of the operated hips formerly in stageII show further progression of radiological necrosis. In stageIII all hips eventually show progress of femoral head collapse and the need of atotal hip replacement. Concerning the outcome of afree vascularized bone graft (fibula flap) compared to the pedicled vascularized graft from the iliac crest for treatment, the anatomically demanding area and ahigher complication rate should be considered even though the cancellous bone of the iliac crest is biologically ideal. Nowadays afree vascularized fibular graft is the most frequently used bone graft for treatment of femoral head necrosis.