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Osteonecrosis of the femoral head (ONFH) is a multi-factorial disease with relatively unknown aetiology and unclear pathogenetic mechanism. Left untreated, the natural history of the disease is progressive collapse of the femoral head and destruction of the joint with substantial pain and disability. The disease primarily affects younger individuals, in whom many surgeons will typically prefer to delay performing total hip arthroplasty (THA). Therefore, increasing attention has been given to a wide variety of femoral head-preserving procedures. The use of non-vascularized bone grafting (NVBG) to treat ONFH has mainly been advocated for pre-collapse and select, early post-collapse lesions. Currently, multiple studies reported on various non-vascularized bone grafting techniques of treating ONFH. Clinical outcomes have varied widely, with success rates reported between 55 and 87% in the short- to mid-term, with long-term results lacking. Due to the current paucity of studies, in this review we aimed to discuss (1) indications, (2) techniques, and (3) outcomes of non-vascularized bone grafting used to treat osteonecrosis of the femoral head.

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Gray-scale ultrasonography was used to detect, localize, and guide percutaneous aspirations of peritransplant fluid collections. Fifty-one (51%) transplant recipients had abnormal fluid collections; 18 of these patients required surgery. Analysis of the 23 proved fluid collections (10 lymphocytes, 7 abscesses, 4 urinomas, and 2 hematomas) revealed certain sonographic and temporal patterns. Lymphoceles were the most common cause of an obstructed transplant and were usually septated. Most of the undiagnosed fluid collections were small and crescentic and were located in the abdominal wall. They usually did not enlarge or resolve on serial ultrasound examinations. A role for ultrasound in the management of peritransplant fluid collections is proposed.

No abstract