Vascular-Pedicled Bone Grafts and Hip Reconstruction

Abstract

The hip joint is the most important weight-bearing joint in the human body, and its integrity is of vital importance to ambulation and general well-being. Although total joint replacement has led to tremendous advances in the reconstruction of the hip joint, the artificial replacement is still considered to be inferior to the natural articular components; the active biological activities of the latter enable them to last much longer and make them much more capable of resisting adverse conditons, both biomechanical and environmental. Therefore, whenever total joint replacement is obviously not the treatment of choice, as in the case of young patients (aged 20–40 years), special problems arise when the femoral head is at risk of destruction or collapse. These problems are encountered when large bony defects occur in the proximal femur after tumour resection, when there is non-union of femoral neck fracture (whether or not the viability of the femoral head is threatened) and when there is avascular necrosis of the femoral head. Attempts have been made in the past to treat these problems, but on the whole, the results are uniformly unsatisfactory. The procedures attempted included the use of free bone grafts. If these grafts were small, they were mechanically weak, and if large, it was difficult to get them revascularised. These difficulties might explain the high rates of failure [1, 2].