Fresh autogenous grafts and osteochondral allografts for the treatment of segmental collapse in osteonecrosis of the hip

The treatment of femoral head osteonecrosis and segmental collapse with fresh autogeneous grafts and osteochondral allografts is in the experimental stages. The early results suggest that the grafts may be a satisfactory intermediate conservative alternative to radical surgery. Strict adherence to the criteria for selection of candidates for grafting and meticulous surgical technique are essential prerequisites if optimal results are to be achieved. Factors favoring the choice of autologous or allogeneic grafts in osteonecrosis of the hip are the clinically insignificant immunologic reaction and viable hyaline cartilage. Immunosuppressive agents are nonessential. Failure does not preclude artificial resurfacing, endoprosthetic replacement, or total hip arthroplasty.