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FOLLOW-UP OF COMPLETE DEBRIDEMENT AND CANCELLOUS BONE GRAFTING OF THE FEMORAL HEAD FOR AVASCULAR NECROSIS



Abstract

The purpose of our study was to ascertain whether complete debridement and cancellous bone grafting prevents the progression of early (Ficat stages I to III) non-traumatic avascular necrosis of the femoral head.

Between 1995 and 2001 15 patients presented at the Pre-toria Academic Hospital with atraumatic avascular necrosis of the femoral head. The necrosis was staged according to the modified Ficat classification based on radiographs and on MRI and/or a bone scintigram: there were five Ficat stage-I, six stage-IIA, two stage-IIB and two stage-III hips. Postoperatively the diagnosis was confirmed histologically in all cases.

Using the Harris Hip Score (HHS), patients were clinically evaluated preoperatively and at each follow-up examination. The Ficat classification was also determined at each follow-up. A lateral approach with a trap door procedure was followed by debridement of the necrotic area and autogenous bone grafting. The mean follow-up period was 20 months, with the longest follow-up six years. There was no progression of disease in the five patients with Ficat stage-I hips, and there was a mean HHS improvement of 40 points. The six Ficat stage-IIA and two stage-IIB patients also had no progression of disease and exhibited 53 and 78 point respectively HHS improvements. Both Ficat stage-III patients progressed to total hip arthroplasties after a mean of 17 months.

We conclude that debridement and cancellous bone grafting is effective in treating patients with Ficat stage-I to IIB avascular necrosis.

The abstracts were prepared by Professor M. B. E. Sweet. Correspondence should be addressed to him at The Department of Orthopaedic Surgery, Medical School, University of Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193 South Africa