Sartorius muscle pedicle iliac bone graft for the treatment of avascular necrosis of femur head.

Raju Vaishya,Vipul Vijay,Nishint Gupta,Amit Kumar Agarwal

doi:10.1093/jhps/hnw012

Raju Vaishya, Vipul Vijay + Show 2 more

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https://doi.org/10.1093/jhps/hnw012

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Abstract

Avascular necrosis (AVN) of femoral head needs to be addressed early in the course of the disease, to prevent progression to osteoarthritis. A revascularizing procedure which can help preserve the head should be considered in young adults to alleviate the need for total hip arthroplasty. We included 40 cases (53 hips) of AVN of femoral head operated with Sartorius muscle pedicle iliac bone grafting, done by the senior author. Early post-operative rehabilitation was done. The weight bearing was delayed for 6 weeks. All the patients were followed clinically and radiologically at regular intervals. The operated femoral heads, were grouped according to Ficat’s staging: 24 in stage IIA (45.3%), 22 in stage IIB (41.5%) and 07 in stage III (13.2%). The average duration of surgery was 85 min (range: 55–130 min). The total duration of follow-up was average 4.2 years (range: 2.2–15 years).The Harris hip score was excellent (>90) in 18 hips (33.96%), good (80–89) in 24 hips (45.28%), fair (70–79) in 9 hips (17%) and poor (<70) in 2 hips (3.7%). AVN of the femoral head is a painful and disabling condition in young adults. Sartorius muscle pedicle bone graft technique allows adequate decompression, re vascularization and osteogenesis of the femur head in Ficat’s stage IIa, IIb and III, in young adults. This is an effective and easy technique to adopt with excellent to good results in 80% cases and is associated with only minimal complications.

Highlights

Avascular necrosis (AVN) of the femoral head is a painful and disabling condition
A revascularizing procedure which can help preserve the head should be considered in young adults to alleviate the need for total hip arthroplasty
We included 40 cases (53 hips) of AVN of femoral head operated with Sartorius muscle pedicle iliac bone grafting, done by the senior author

Summary

Introduction

Avascular necrosis (AVN) of the femoral head is a painful and disabling condition. It mostly affects the people in third and fifth decade of the life [1]. Core decompressions reduce intraosseous pressure and decrease the pain, but it does not enhance the vascularization of necrosed head adequately, especially in an advanced stage of the disease. It is better supplemented with various bone grafting or muscle pedicle grafting techniques, to enhance vascularity and healing of the lesion. There are several techniques described to enhance the vascularization of the femur head, like core decompression with vascularized and non-vascularized bone grafting, various types of muscle pedicle grafts, etc These procedures have shown favorable results in stages IIa, IIb and III [7].

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