Outcome of nonvascularized bone grafting for osteonecrosis of the femoral head.

Osteonecrosis is a disease with a wide-ranging etiology and poorly understood pathogenesis seen commonly in young patients. Various head-preserving procedures have been used for this disease to avert the need for total hip replacement. These include various vascularized and nonvascularized bone grafting procedures. We will describe the use of bone-grafting through a window at the femoral head-neck junction for the treatment of osteonecrosis of the femoral head. Bone morphogenetic protein (BMP)-enriched allograft was used to avoid donor site morbidity. Nineteen patients (21 hips) were followed up for a mean of 48 months (range, 36-55 months) after a bone grafting procedure in which the diseased bone was replaced by a bone graft substitute (combination of demineralized bone matrix, processed allograft bone chips, and a thermoplastic carrier). Eighteen of 21 hips (86%) were clinically successful at latest followup. Two of these patients have minimal radiographic progression (< 2 mm head collapse). This procedure is straightforward technically, led to low morbidity, and did not necessitate procurement of donor site bone graft. This procedure may be effective at avoiding or forestalling the need for total hip arthroplasty in young patients with early to intermediate stages of osteonecrosis of the femoral head.