The gluteus minimus muscle pedicle graft in the treatment of femoral head avascular necrosis

The treatment of the nonelderly adult patient with avascular necrosis (AVN) of the femoral head remains a challenge. We treated 16 patients (20 hips) afflicted with Ficat stage II or III femoral head AVN with a pedicle bone-grafting technique using the gluteus minimus. The procedure involves core decompression of the osteonecrotic segment of the femoral head followed by introduction of a corticocancellous bone graft from the anterior femur into the decompressed segment. The graft contains the insertion of the gluteus minimus. Each case was retrospectively evaluated to determine the incidence of clinical and roentgenographic progression of the disease after the procedure. The follow-up period averaged 47 months clinically and 33 months radiographically. Twelve (60%) of the cases were considered a success symptomatically;, 8 (40%) of the hips demonstrated radiographic stabilization. This procedure is bei ng presented as a possible "biologic" option in the treatment of femoral head AVN.