Vascularized iliac periosteal transfer for the treatment of avascular necrosis of the femoral head and a new evaluation grading system.

OBJECTIVE

To introduce the surgical technique and a new evaluation grading system and to report the results of the vascular iliac periosteal grafting for avascular necrosis of the femoral head.

PATIENTS AND METHODS

From 1983 to 1994, a new technique was used to treat 75 hips of 60 patients with avascular necrosis (AVN) of the femoral head using the vascular iliac periosteum with deep iliac circumflex artery and vein pedicle. 52 patients (66 hips) were followed up for 3-11 years and all patients were evaluated clinically and roentgenographically according to the new evaluation grading system for AVN by the Chinese Society for Osteonecrosis.

RESULTS

Preoperatively, the average AVN score was 57 pts., and all patients had significant pain and limp. Five hips were at Ficat/Arlet stage IV, 40 were at stage III, and 21 were at stage II. Postoperatively, the average AVN score was 83 pts., 47 hips were pain free, 13 had mild pain, and 6 had moderate pain. At the latest follow-up, according to the new evaluation grading system, 26 hips were graded as excellent, 32 hips as good, 5 hips as fair, and 3 hips as poor.

CONCLUSION

It is one of the better alternatives that can prevent the necrotic femoral head from progressing to collapse and promote revascularization and new bone formation by a direct mechanism, and it is suitable for the treatment of AVN of the stage I to III.