Treatment of femoral head necrosis with vascularized iliac crest transplants.

The development of microsurgical methods has allowed for the use of vascularized bone transplants in the treatment of femoral head necrosis, particularly for Stages II, III, and IV according to the Association Internationale de Recherche sur la Circulation Osseuse classification system. Eighty patients with avascular necrosis of the femoral head were treated with vascular pedicled iliac crest transplant, perfused by the circumflexed ilium profunda artery between 1988 and 1996. On average, the postoperative followup was 5 years. Evaluation was based on the Harris hip score, and clinical and radiologic examination. Clinical results according to the Harris hip score were good or excellent in 86.6% of the patients. Radiologic appearance during the followup remained stable in 56.1% of the patients according to the classification system of the Association Internationale de Recherche sur la Circulation Osseuse. These findings are compatible with the findings of other studies in which vascularized bone transplants were used and approximately 50% of the patients with Stages II, III, and IV, according to the classification of the Association Internationale de Recherche sur la Circulation Osseuse had an unchanged stage of disease 5 to 6 years after the procedure.