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
