Tensor fascia lata muscle pedicle grafting for avascular necrosis femoral head

Mohamed Ashraf, Subramanian V., Narayanan S. K., Manu Mohan


Background: Osteonecrosis of femoral head (AVN) is a disabling condition with ill-defined etiology and pathogenesis. In more than 60% it leads to osteoarthritis of hip joint. Treatment for this condition includes both operative and non-operative methods with variable success rates. Surgical options being aimed at both conservation of femoral head and arthroplasty of hip joint. Aim of our study was to evaluate the efficacy of tensor fascia lata muscle pedicle grafting in the management of osteonecrosis of femoral head.

Methods: 27 cases with a mean age of 38.7 years (range from 24 to 52) who underwent tensor fascia lata muscle pedicle grafting in the management of  osteonecrosis  of femoral head were prospectively evaluated with a  mean follow up period of  7.3 years (range from 3 to 12 years). Watson-Jones approach was used in all patients. Average hospital stay was 12 days. Harris hip score was used for the evaluation of clinical outcome.

Results: In our series of 27 cases, the Harris hip score was excellent (90-100) in 19, good (80-89) in 5, fair (70-79) in 2 and  poor  (<70) in 1 case at final follow up.

Conclusions: Tensor fascia lata muscle pedicle grafting is an effective, technically easier, pain relieving head-preserving procedure and will improve outcome in properly selected patients with osteonecrosis of femoral head. 


Avascular necrosis, ONFH, Femur head, Osteonecrosis, Muscle pedicle grafting, Tensor fascia lata

Full Text:



Kenzora JE, Glimchar MJ. Cell stress theory. OCNA. 1985;16:669.

Powell C, Chang C, Naguwa SM, Cheem AG, Gershwin ME. Steroid induced osteonecrosis: An analysis of steroid dosing risk. Autoimmun Rev. 2010;9:721-43.

Assouline-Dayan Y, Chang C, Greenspan A, Shoenfeld Y, Gershwin ME. Pathogenesis and natural history of osteonecrosis. Semin Arthritis Rheum. 2002;32:94-124.

LaPorte DM, Mont MA, Mohan V, Jones LC, Hungerfor DS. Multifocal osteonecrosis. J Rheumatol. 1998;25:1968-74.

Lang P, Jergesen HE, Genant HK, Moseley ME, Schulte-Mönting J. Magnetic resonance imaging of the ischemic femoral head in pigs. Dependency of signal intensities and relaxation times on elapsed time. Clin Orthop Relat Res. 1989;244:272-80.

Fordyce MJ, Solomon L. Early detection of avascular necrosis of the femoral head by MRI. J Bone Joint Surg Br. 1993;75:365-7.

Konishiike T, Makihata E, Tago H, Sato T, Inoue H. Acute fracture of the neck of the femur. An assessment of perfusion of the head by dynamic MRI. J Bone Joint Surg Br. 1999;81:596

Hirata T, Konishiike T, Kawai A, Sato T, Inoue H. Dynamic magnetic resonance imaging of femoral head perfusion in femoral neck fracture. Clin Orthop Relat Res. 2001;393:294-301.

Mitchell DG, Rao VM, Dalinka MK, Spritze CE, Alav A, Steinberg ME, et al. Femoral head avascular necrosis: Correlation of MR imaging, radiographic staging, radionuclide imaging, and clinical findings. Radiology. 1987;162:709-15.

Marcus ND, Enneking WF, Massam RA. The silent hip in idiopathic aseptic necrosis: treatment by bone grafting. J Bone Joint Surg [Am]. 1973;55:1351–66.

Sugioka Y. Transtrochanteric anterior rotational osteotomy of the femoral head in the treatment of osteonecrosis affecting the hip. Clin Orthop. 1978;130:191–201.

Sugioka Y, Katsuki I, Hotokebuchi T. Transtrochanteric rotational osteotomy of the femoral head for the treatment of osteonecrosis: follow-up statistics. Clin Orthop. 1982;169:115–26.

Steinberg ME, Brighton CT, Corces A, Hayken GD, Steinberg DR, Strafford B, et al. Osteonecrosis of the femoral head: results of core decompression and grafting with and without electrical stimulation. Clin Orthop. 1989;249:199–208.

Ohzono K, Saito M, Sugano N, Takaoka K, Ono K. The fate of non-traumatic avascular necrosis of the femoral head: a radiologic classification to formulate prognosis. Clin Orthop. 1992;277:73–8.

Ficat RP. Idiopathic bone necrosis of the femoral head: early diagnosis and treatment. J Bone Joint Surg [Br]. 1985;67:3–9.

Kerboul M, Thomine J, Postel M, Merle d’Aubigné R. The conservative surgical treatment of idiopathic aseptic necrosis of the femoral head. J Bone Joint Surg Br. 1974;56:291-6.

Steinberg ME, Steinberg DR. Classification systems for osteonecrosis: an overview. Orthop Clin N Am. 2004;35:273–83.

Gardeniers JWM. A new international classification of osteonecrosis of the ARCO Committee on Terminology and Classification. ARCO Newsletter. 1992;4:41–6.

Jackson SM, Major NM. Pathologic conditions mimicking osteonecrosis. Orthop Clin N Am. 2004;35:315–20.

Koo KH, Kim R, Ko GH, Song HR, Jeong ST, Cho SH. Preventing collapse in early osteonecrosis of the femoral head: a randomized clinical trial of core decompression. J Bone Joint Surg [Br]. 1995;77:870–4.

Fairbank AC, Bhatia D, Jinnah RH, Hungerford DS. Long-term results of core decompression for ischaemic necrosis of the femoral head. J Bone Joint Surg [Br]. 1995;77:42–9.

Steinberg ME. Core decompression of the femoral head for avascular necrosis. Can J Surg. 1995;38(1):18-24.

Chang MC, Chen TH, Lo WH. Core decompression in treating ischaemic necrosis of femoral head. zhonghua-taipei. 1997;60:130-6.

Eyb R, Kotz R. The transtrochanteric anterior rotational osteotomy of Sugioka. Arch Orthop Trauma Surg. 1987;106:161–7.

Kempf I, Karger C, Bikhalil JA, Kempf JF. L’oste´otomie de retournement en arrie`re de la teˆte fe´morale dansla ne´crose de la teˆte. Rev Chir Orthop. 1984;70:271–82.

Langlais F, Fourastier J, Gedouin JE, Ropars M, Lambotte JC, Thomazeau H. Can rotation osteotomy remain effective for more than ten years? Orthop Clin North Am. 2004;35:345–51.

Malizos KN, Soucacos PN, Beris AE. Analysis of failures after vascularized fibular grafting in femoral head necrosis. Orthop Clin N Am. 2004;353:353-7.

Urbaniak JR, Coogan PG. Long term follow-up of 103 cases of osteonecrosis of the femoral head treated by free vascularized fibular graft. J Bone Joint Surg [Am]. 1995;77(5):681-94.

Babis GC, Soucacos PN. Effectiveness of total hip arthroplasty in the management of hip osteo-necrosis. Orthop Clin N Am. 2004;35(2004):359-64.

Meyer MH. Osteonecrosis of the femoral head. Pathogenesis and long-term results of treatment. Clin Orthop. 1988;231:51-61.

Baksi DP. Treatment of osteonecrosis of the femoral head by drilling and muscle pedicle bone grafting. J Bone Joint Surg (Br). 1991;73:241-5.