Impaction Bone Grafting

Osteonecrosis of the femoral head (ONFH) is a disease that commonly affects young adults progressing to collapse and osteoarthritis. Joint-preserving procedures are preferred treatments to prevent the progression to collapse and subsequent osteoarthritis [1]. Since core decompression was first described by Ficat and Arlet [2], several head-preserving procedures combined with core decompression including vascularized [3, 4] or nonvascularized bone graft [5, 6] from the fibula, iliac crest, or tibia have been performed to provide mechanical support and biological augmentation aiding bone healing [7, 8]. Most of these procedures, however, demonstrated limited successful outcomes for treating ONFH in early stage [6, 9, 10]. Some of them are technically demanding with extensive surgical time and showed donor site morbidity [11]. The residual graft can prevent optimal positioning and canal fit of the stem in later possible total hip arthroplasty (THA) after failed nonvascularized or vascularized fibular or tibial grafting [12, 13]. On the contrary, bone impaction grafting is relatively simple and does not take extensive surgical time. It does not produce donor site morbidity and does not disturb the procedure in future THA [14].