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J Am Acad Orthop Surg, Vol 12, No 2, March/April 2004, 96-105.
© 2004 the American Academy of Orthopaedic Surgeons
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Management of Ficat Stage III and IV Osteonecrosis of the Hip

Paul E. Beaulé, MD, FRCSC and Harlan C. Amstutz, MD

Dr. Beaulé is Assistant Clinical Professor, Joint Replacement Institute, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA. Dr. Amstutz is Medical Director, Joint Replacement Institute.

Reprint requests: Dr. Beaulé, Joint Replacement Institute, 2400 South Flower Street, Los Angeles, CA 90007.

Management of Ficat stage III and IV osteonecrosis of the hip remains controversial. Because patients usually require a surgical intervention in their mid 30s, the initial procedure is often the first step in a lifelong treatment plan. Long-term results of total hip arthroplasty in these young, active patients have been disappointing. New alternative bearing surfaces (metal-on-metal, ceramic-on-ceramic, and highly cross-linked polyethylene) and improved methods of fixation may lead to better long-term results. Nevertheless, bone- and joint-preserving procedures, such as free-vascularized fibular graft, trapdoor grafting, redirectional osteotomy, or hemiresur-facing hip arthroplasty, should be considered. The choice of option depends on patient age, the cause of osteonecrosis, the extent of femoral head involvement, and the condition of the acetabular articular cartilage. The goals of treatment are to relieve pain, improve function, minimize morbidity, and maintain options for secondary procedures.




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