Vascularized Greater Trochanter Bone Flap Transfer for Treatment of ARCO Stage-IIB to IIIB Osteonecrosis of the Femoral Head

Background: The goal of a vascularized bone flap transfer is to replace the necrotic bone of the femoral head, restore the blood supply, and provide new bone and mechanical support for the femoral head. Description: The major steps of the procedure that are demonstrated in this article are: (1) using the anterolateral approach to the hip, the incision is made; (2) the interval between the rectus femoris and vastus lateralis is split, the transverse branch of the lateral femoral circumflex artery is identified, and the pedicle is isolated and protected; (3) the vascularized bone flap is harvested from the greater trochanter; (4) necrotic bone is debrided through a bone window made at the junction of the femoral neck and head; (5) the cancellous bone from the greater trochanter is implanted, and the vascularized bone flap is positioned and fixed; and (6) the wound is closed in layers. Complications are rare, and full weight-bearing is allowed after 3 months postoperatively. Alternatives: Free vascularized fibular graft. Rationale: Compared with a free vascularized fibular grafting technique, vascularized bone-grafting of the greater trochanter has the advantages of being less invasive, incurring lower donor-site morbidity, and not requiring any microsurgical technique because there is no vascular anastomosis.