Management of nontraumatic osteonecrosis of the femoral head using impaction bone grafting via a light bulb window through a safe surgical dislocation approach

Purpose
The aim was to appreciate the clinical and radiological results of impacted bone graft via bone window on the head-neck junction for treatment of nontraumatic avascular necrosis of femoral head through a safe surgical dislocation approach.
Patients and methods
A total of 33 hips in 26 patients were managed with femoral head osteonecrosis by impaction of autogenous iliac bone graft via bone window on the head-neck junction (light bulb) through a safe surgical dislocation approach. There were eight females and 18 males, with a mean age of 29.06 years (ranging from 14 to 46 years) with stage II and III avascular necrosis of the femoral head according to Association Research Circulation Osseous (ARCO). The results were studied based on variations in the Harris hip score and progress in radiographic stages.
Results
These 26 patients were followed up from 24 to 48 months (mean: 33.9 months). The mean Harris hip score was 82.78 (range from 66 to 95) after last follow-up when compared with 60.45 (range from 41 to 85) preoperatively. The clinical success for ARCO stage II was 75% (100% in stage IIA, 83.3% in stage IIB, and 50% in stage IIC) and for ARCO stage III was 43.5% (70% in stage IIIA, 60% in stage IIIB, and 0% in stage IIIC), whereas the overall radiographic progression was found in 15 of 33 hips (45.4%), where nine of them (27.3%) progressed to radiographic failure (femoral head collapse) and required total hip arthroplasty.
Conclusions
Impaction of autogenous bone graft through a safe surgical dislocation via a bone window creates a mechanical and biological condition for graft incorporation, and therefore, it may be the treatment of choice in nontraumatic osteonecrosis of the femoral head at the precollapse stage (stage II and early III), especially with a small-sized lesion, with a better outcome in idiopathic type.