Aseptic necrosis of the femoral head. Treatment with bone grafts of doubtful value.

A heterogeneous group of 17 patients with aseptic necrosis of the femoral head had treatment of 23 hips by bone grafting. Phemister-type tibial grafts were used in 20 and iliac grafts in 3. All hips were evaluated before and after grafting according to roentgenographic stage of disease and the Hospital for Special Surgery Rating System. We found no exact correlation between roentgenographic stage and clinical manifestations. It is concluded that bone grafting treatment of this condition is warranted in only the very earliest stage of the disease when roentgenographic examination shows that normal femoral head contour is preserved and there are only subtle mottled densities scattered throughout the anterosuperior region. In this series, no benefit was derived from bone grafting in later stages of the disease.