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Anales de la Facultad de Ciencias Médicas (Asunción)

versión impresa ISSN 1816-8949


CAPPELLO RIVEROS, José Mario. Vascularized iliac crest graft with muscle pedicle (m. sartorius) in patient with osteonecrosis of the hip. An. Fac. Cienc. Méd. (Asunción) [online]. 2005, vol.38, n.3, pp.9-21. ISSN 1816-8949.

      The osteonecrosis of the femoral head, also known as aseptic osseous necrosis of the femoral head, consists of a disease in the sanguineous flow of the osseous tissue of the femoral head with posterior infarct of the tissue. The main problem of this pathology is that, for the moment, there is no ideal treatment that relieves pain, prevents the damage of the hip and preserves the femoral head. The goal should be to preserve the hip whenever possible.       The diagnosis and the stabilization are fundamental in order to establish a prognosis. The radiography and the nuclear magnetic resonance are the most accurate elements for an early diagnosis and to see the size, the deepness and the location of the lesion. This is why we use the Pensilvania classification (modification of the ARCO classification) to classify the pathology and give it a follow up. For this study 40 vascularized grafts has been chosen in 34 patients (6 bilateral) with a follow up of 10 moths to 9 years.       The chosen patients were young adults with osteonecrosis of the femoral head, assisted in Room XI of the “Clinics Hospital” from the “School of Medicine, National University of Asunción.” (21) and private patients (13) between 1996 and 2004.       Conceptually, is proposed a type of surgery that is the “Vascularized Iliac crest with muscle pedicle in osteonecrosis of the hip” that removes the dead tissue and replaces it with viable osseous tissue, which in addition to revascularization is able to be a support to prevent the collapse of the femoral head.In the analysis of the results of the postoperative, in the evaluation of the pain, the ability to walk and the mobility, the following was found: 82% (28/34) of satisfactory results; 16 of them (57%) with good results and 5 patients (18%) with very good results, who live without anti-inflamatories or physical therapy, there is a group of 7 patients (25%) with an acceptable result who need anti-inflamatories occasionally (1 or 2 tablets per week) Out of 8% (6/34) of the patients with unsatisfactory results, 2 (33%) obtained limited results and 4 (67%) had bad results; 5 patients had a change to THA (Total Hip Arthroplasty ) and 1 patient suffered pain that was relieved with anti-inflamatories who refused to have THA. The average of the global score obtained in the postoperative was of significant improvement in comparison with the preoperative which corresponds with a good score. The same was observed when pain, ability to walk and mobility were evaluated individually.       If we count the pre and postoperative of the patients we can see that: • The mobility of the hip in general was not modified. • The ability to walk was increased in most patients. • The pain was less intense after the surgery, decreasing the use of anti-inflamatories and analgesics. • The patients’ expectations of the surgery, in general, were satisfied       The revascularization of the femoral head comes forth as a valid alternative to preserve it, stopping the progression of the disease before the subchondral fracture or diminish the progression of the arthrosis and destruction of the femoral head after the subchondral fracture has happened.

Palabras clave : osteonecrosis; vascularized graft; revascularization.

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