Osteonecrosis Femoral Head Treatment by Core Decompression and ILIAC CREST-TFL Muscle Pedicle Grafting

Osteonecrosis of femoral head is a painful disabling condition seen in association with many disorders like corticosteroids consumption, alcohol abuse, haemoglobinopathy (sickle cell disease, coagulopathies), certain renal, hepatic and skin disorders commonly affecting young patients ranging from 20-40 years.1-3 It is now recognized as a major musculo-skeletal problem mostly affecting the young people in their productive years of life. It is often characterized by relentless progression despite treatment, resulting in to subchondral fracture, collapse and painful arthrosis.4 Hence it is essential to diagnose and treat the patients of osteonecrosis early to prevent any further disintegration and collapse of femoral head. Advanced osteonecrosis with secondary osteoarthritis is reported in 5% to 18% of total patients undergoing total hip replacement in the US.4-7 Aim of the treatment in osteonecrosis is to reduce the intraosseous pressure and to perform the head-preserving procedure, which will cause early revascularization of ischemic head. Various types of muscle pedicle grafting after core decompression are indicated early in the disease, depending upon the stage of the disease and have shown excellent results in revascularization of femoral head and prevention of collapse.