Nonvascularized bone grafting defers joint arthroplasty in hip osteonecrosis

Clin Orthop Relat Res. 2008 May;466(5):1125-32. doi: 10.1007/s11999-008-0211-x.


A variety of nonvascularized bone grafting techniques have been proposed with varying degrees of success as treatment alternatives for osteonecrosis of the femoral head. The success of these procedures may be enhanced using ancillary growth and differentiation factors. We retrospectively reviewed 33 patients (39 hips) with osteonecrosis of the hip who had nonvascularized bone grafting procedures with supplemental OP-1. We compared the outcomes in this cohort to similar patients treated nonoperatively or with other nonvascularized bone grafting procedures. We used a trapdoor to make a window at the head-neck junction to remove necrotic bone and packed the excavated area with autogenous cancellous bone graft, marrow, and OP-1. The minimum followup was 24 months (mean, 36 months; range, 24-50 months). We performed no further surgery in 25 of 30 small- and medium-sized lesions (80%) but did in two of nine large lesions. Hips with Ficat Stage II disease were not reoperated in 18 of 22 cases during the followup periods. Our short-term results compare similarly to nonoperative treatment and other reports of nonvascularized bone grafting. With the addition of ancillary growth factors, these procedures effectively reduce donor site morbidity and may defer joint arthroplasty in selected patients.

MeSH terms

  • Adult
  • Arthroplasty, Replacement, Hip*
  • Bone Marrow Transplantation*
  • Bone Morphogenetic Protein 7
  • Bone Morphogenetic Proteins / pharmacology
  • Bone Morphogenetic Proteins / therapeutic use*
  • Bone Transplantation / methods*
  • Female
  • Femur Head / drug effects
  • Femur Head / physiopathology
  • Femur Head / surgery*
  • Femur Head Necrosis / drug therapy
  • Femur Head Necrosis / etiology
  • Femur Head Necrosis / physiopathology
  • Femur Head Necrosis / surgery*
  • Follow-Up Studies
  • Hip Joint / drug effects
  • Hip Joint / physiopathology
  • Hip Joint / surgery*
  • Humans
  • Male
  • Middle Aged
  • Osseointegration / drug effects*
  • Reoperation
  • Retrospective Studies
  • Severity of Illness Index
  • Time Factors
  • Transforming Growth Factor beta / pharmacology
  • Transforming Growth Factor beta / therapeutic use*
  • Treatment Failure
  • Treatment Outcome


  • BMP7 protein, human
  • Bone Morphogenetic Protein 7
  • Bone Morphogenetic Proteins
  • Transforming Growth Factor beta