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Vascularized Iliac Bone Graft Using Deep Circumflex Iliac Vessels for Idiopathic Osteonecrosis of the Femoral Head

Kunihiko Tokunaga, Muroto Sofue, Yomcmrou Dohmae, Kenji Watanabe, Masaki Ismzaka, Yutaka Ohkawa, Toshio Iga, and Naoto Endo

Summary. This study aimed to analyze the clinical and radiologic findings of 59 hips from 46 patients who underwent vascularized iliac bone graft (VIBG) using the deep circumflex iliac artery and vein for idiopathic osteonecrosis of the femoral head (ION). Progress rate of femoral head collapse was 76.3% after VIBG. More than half of the femoral heads collapsed even though they did not show preoperative collapse. Average Japanese Orthopedic Association (JOA) score was 73.3 points, and there was no significant difference between preoperative and postoperative JOA scores. In males, preoperative collapse of the femoral head, bone graft with total curettage of the osteonecrotic lesion, and bilateral VIBG reduced JOA scores. For patients over 30 years old, preoperative collapse, bone graft with total curettage of the osteonecrotic lesion, and abuse of alcohol reduced survival rate after VIBG when the endpoint was set as collapse of the femoral head. These data suggest that young patients suffering from early-stage ION without collapse of the femoral head should be indicated to undergo VIBG. However, VIBG is only a time-saving surgery to postpone performing total arthroplasty or hemiarthroplasty for patients with early-stage ION because VIBG cannot always improve hip function and femoral head deformity.

Key words. Idiopathic osteonecrosis, Femoral head, Vascularized iliac bone graft, Collapse, Time-saving surgery

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