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The use of non-vascularized bone grafts to treat osteonecrosis of the femoral head: indications, techniques, and outcomes

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Abstract

Osteonecrosis of the femoral head (ONFH) is a multi-factorial disease with relatively unknown aetiology and unclear pathogenetic mechanism. Left untreated, the natural history of the disease is progressive collapse of the femoral head and destruction of the joint with substantial pain and disability. The disease primarily affects younger individuals, in whom many surgeons will typically prefer to delay performing total hip arthroplasty (THA). Therefore, increasing attention has been given to a wide variety of femoral head-preserving procedures. The use of non-vascularized bone grafting (NVBG) to treat ONFH has mainly been advocated for pre-collapse and select, early post-collapse lesions. Currently, multiple studies reported on various non-vascularized bone grafting techniques of treating ONFH. Clinical outcomes have varied widely, with success rates reported between 55 and 87% in the short- to mid-term, with long-term results lacking. Due to the current paucity of studies, in this review we aimed to discuss (1) indications, (2) techniques, and (3) outcomes of non-vascularized bone grafting used to treat osteonecrosis of the femoral head.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA

    Assem A. Sultan, Anton Khlopas, Peter Surace, Linsen T. Samuel, Mhamd Faour, Viktor E. Krebs, Kim L. Stearns, Robert M. Molloy & Michael A. Mont

  2. Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, NY, USA

    Nipun Sodhi & Michael A. Mont

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  1. Assem A. Sultan
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  2. Anton Khlopas
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Correspondence to Michael A. Mont.

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Conflict of interest

Assem A. Sultan, MD: nothing to disclose

Anton Khlopas, MD: nothing to disclose

Peter Surace, MD: nothing to disclose

Linsen T. Samuel, MD, MBA: nothing to disclose

Mhamd Faour, MD: nothing to disclose

Nipun Sodhi, BA: nothing to disclose

Viktor Erik Krebs, MD:

Journal of Arthroplasty: editorial or governing board

Stryker: IP royalties; paid presenter or speaker

Stryker Orthopaedics: paid consultant

Kim L Stearns, MD:

Fidiapharma: paid presenter or speaker

Robert M. Molloy, MD:

Stryker: paid consultant; paid presenter or speaker; research support

Zimmer: research support

Michael A Mont, MD:

AAOS: board or committee member

Abbott: paid consultant

Cymedica: paid consultant

DJ Orthopaedics: paid consultant; research support

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Sultan, A.A., Khlopas, A., Surace, P. et al. The use of non-vascularized bone grafts to treat osteonecrosis of the femoral head: indications, techniques, and outcomes. International Orthopaedics (SICOT) 43, 1315–1320 (2019). https://doi.org/10.1007/s00264-018-4056-y

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