Corticosteroid-induced Osteonecrosis of the Femoral Head: Detection, Diagnosis, and Treatment in Earlier Stages

Liu, Li-Hua; Zhang, Qing-Yu; Sun, Wei; Li, Zi-Rong; Gao, Fu-Qiang

Nonvascularized bone grafting (NVBG) basically removes necrotic bones and replaces them with cancellous and/or cortical autografts. It rebuilds the structure of the femoral head and supports the subchondral bone and articular cartilage to avoid collapse. This technique has evolved from the Phemister technique to the Trapdoor technique and Lightbulb technique. Compared with the CD technique, NVBG is more indicated for ARCO stages II and III in the precollapse stage of ONFH. A comparative study that impacted bone graft with or without recombinant human BMP-2 (rhBMP-2) for ONFH using the lightbulb technique indicated that NVBG was an effective hip-preserving surgery in selected patients and that the rhBMP-2 might improve the clinical efficacy and quality of bone repair. [53] The definite indications are ONFH in the precollapse stages or at least in the early postcollapse stages with less than 2-mm collapse and intact articular surface.