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The Challenge of Treating Hip Osteonecrosis in Young Adults

The world of orthopedics is full of unusual problems. Osteonecrosis of the femoral head in young adults is one of the more difficult challenges. Osteonecrosis means bone death. The femoral head is the round ball at the top of the thighbone that fits into the hip socket.

Osteonecrosis can be caused by steroid use, alcohol, trauma, and blood-clotting problems. In some cases, no cause can be found. The first goal in treating osteonecrosis of the femoral head is to save the bone. The second goal is to keep function while relieving pain.

Doctors can use a bone graft from the fibula (the small bone next to the shin bone) in the lower leg to preserve the femoral head. Taken from the cortical bone, the pieces harvested from the fibula have their own blood (vascular) supply. This helps the bone survive in its new location. There, the graft reinforces the outside border of the femoral head. The graft is called a free vascularized fibular graft (FVFG).

If the FVFG fails, the bone will collapse causing even more problems. A total hip replacement may be the next step. However, in a young adult, the implant may not last more than 15 years. That's why the FVFG is done first to prolong the life of the bone.

The authors of this study took on several tasks. They reviewed and summarized different types of implants used to treat patients with osteonecrosis. They also reviewed results based on the cause of the necrosis. Patients with osteonecrosis from steroid or alcohol use had the worst outcomes.

Pain levels and function were measured for patients who had a FVFG before having a total hip replacement. The researchers compared these results with patients who were treated for osteonecrosis without FVFG. As predicted, the younger patients had the worst results.

Revision of the joint implant is common in patients with osteonecrosis. Over 20 percent of the patients had a second operation after total hip replacement. The authors point this out as the main reason to preserve the femoral head with FVFG for as along as possible before replacing the joint.

References: Keith R. Berend, MD, et al. Hip Arthroplasty after Failed Free Vascularized Fibular Grafting for Osteonecrosis in Young Patients. In The Journal of Arthroplasty. June 2003. Vol. 18. No. 4. Pp. 411-419.

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