People who are good candidates for this procedure must have small lesions in the femoral head, good range of motion in the hip, and a lesion which can be moved to a non weight bearing area. Arthroscopy is a surgical procedure in which a camera is inserted into the hip, ankle, shoulder, elbow, or knee joint and the joint surface visualized. This may help the surgeon determine if the joint surface remains intact and the AVN can therefore be treated with a salvage procedure and delay the need for total joint replacement. Loose pieces of cartilage or tears in the cartilage ring around the hip, called the labrum, or the knee, called the meniscus, can also be removed with arthroscopic techniques. Vascularized bone grafting is a sophisticated procedure in which the dead bone is removed, similar to core decompression, and then a bone is removed from the lower portion of the leg, the fibula, with its nutrient blood vessels and then connected to blood vessels near the hip joint providing a source of live bone to support the joint surface of the hip and help heal the AVN process.
Vascularized bone grafting requires two teams of surgeons and microsurgical techniques.
Recent research studies have shown that vascularized bone grafting is superior to core decompression in the treatment of AVN of the hip. A great deal of research work on AVN and the development of Vascularized bone grafting was done at Duke University where Dr. Berend and Dr. Crites received their Orthopaedic Training. Numerous vascularized bone grafting procedures have been performed at the Center for Hip and Knee Surgery.