{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:35:48Z","timestamp":1787754948559,"version":"build-2784847793"},"reference-count":12,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JBJS Essential Surgical Techniques"],"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>\n                      Osteonecrosis of the femoral head often affects young active adults and leads to destruction of the hip joint and severe arthritis\n                      <jats:sup>1\u20134<\/jats:sup>\n                      . Despite improvements in hip arthroplasty design and techniques, it is unlikely that prosthetic replacements will endure for life. Alternatively, various head-preserving procedures have been used to avert or delay the need for a total hip arthroplasty\n                      <jats:sup>5\u201311<\/jats:sup>\n                      . Vascularized iliac bone flap transfer is a joint-preserving procedure that can be considered for younger patients with early or middle-stage osteonecrosis of the femoral head.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Description:<\/jats:title>\n                    <jats:p>The major steps of the procedure include (1) an anterior approach to the affected hip, (2) creation of a bone flap from the iliac crest pedicled with the ascending branch of the lateral circumflex femoral artery, (3) obtaining cancellous bone from the iliac crest, (4) exposure of the anterior aspect of the femoral neck, (5) creation of a 2 \u00d7 2-cm window at the junction of the femoral head and neck, (6) debridement and removal of the necrotic bone, (7) implantation of the cancellous bone and vascularized bone flap, (8) fixation of the bone flap, and (9) layer-by-layer wound closure. Complications are rare, and full weight-bearing is allowed at 6 months postoperatively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Alternatives:<\/jats:title>\n                    <jats:p>Alternatives to the procedure include core decompression, nonvascularized bone-grafting, free vascularized fibular grafting, and vascularized greater trochanter grafting.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Rationale:<\/jats:title>\n                    <jats:p>Various femoral head-preserving procedures have been reported. Core decompression is an effective femoral head-preserving procedure and is recommended as the first surgical treatment option for symptomatic small to medium-sized precollapse lesions. However, outcomes are poor when a patient has a large lesion or femoral head collapse. The advantage of vascularized iliac bone flap transfer is that it allows femoral head decompression, restores blood supply, and provides structural support. Thus, this procedure can be performed in patients with later osteonecrosis stages before hip osteoarthritis has progressed.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.st.18.00023","type":"journal-article","created":{"date-parts":[[2019,2,15]],"date-time":"2019-02-15T06:48:11Z","timestamp":1550213291000},"page":"e5","source":"Crossref","is-referenced-by-count":12,"title":["Vascularized Iliac Bone Flap Transfer for Early and Middle Stages of Osteonecrosis of the Femoral Head"],"prefix":"10.2106","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8611-0558","authenticated-orcid":false,"given":"Dewei","family":"Zhao","sequence":"first","affiliation":[{"name":"Zhongshan Hospital of Dalian University, Dalian, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7022-5588","authenticated-orcid":false,"given":"Benjie","family":"Wang","sequence":"additional","affiliation":[{"name":"Zhongshan Hospital of Dalian University, Dalian, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3531-415X","authenticated-orcid":false,"given":"Baoyi","family":"Liu","sequence":"additional","affiliation":[{"name":"Zhongshan Hospital of Dalian University, Dalian, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2019,3,26]]},"reference":[{"issue":"2","key":"bib1-20230812","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1007\/s11999-011-2050-4","article-title":"Which factors influence preservation of the osteonecrotic femoral head?","volume":"470","author":"Lieberman","year":"2012","journal-title":"Clin Orthop Relat Res."},{"issue":"19","key":"bib2-20230812","doi-asserted-by":"crossref","first-page":"1604","DOI":"10.2106\/JBJS.O.00071","article-title":"Nontraumatic osteonecrosis of the femoral head: where do we stand today? A ten-year update","volume":"97","author":"Mont","year":"2015","journal-title":"J Bone Joint Surg Am."},{"issue":"5","key":"bib3-20230812","first-page":"1117","article-title":"Nontraumatic osteonecrosis of the femoral head: ten years later","volume":"88","author":"Mont","year":"2006","journal-title":"J Bone Joint Surg Am."},{"issue":"1","key":"bib4-20230812","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1016\/j.jbspin.2011.02.020","article-title":"Are the results of multiple drilling and alendronate for osteonecrosis of the femoral head better than those of multiple drilling? A pilot study","volume":"79","author":"Kang","year":"2012","journal-title":"Joint Bone Spine."},{"issue":"4","key":"bib5-20230812","doi-asserted-by":"crossref","first-page":"8342","DOI":"10.4238\/2014.October.20.10","article-title":"Porous tantalum rods for treating osteonecrosis of the femoral head","volume":"13","author":"Liu","year":"2014","journal-title":"Genet Mol Res."},{"issue":"3","key":"bib6-20230812","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1007\/s00402-013-1919-y","article-title":"The clinical and radiographic results of intertrochanteric curved varus osteotomy for idiopathic osteonecrosis of the femoral head","volume":"134","author":"Hamanishi","year":"2014","journal-title":"Arch Orthop Trauma Surg."},{"key":"bib7-20230812","doi-asserted-by":"crossref","first-page":"125","DOI":"10.2174\/1874325020140515001","article-title":"Invasive electromagnetic field treatment in osteonecrosis of the femoral head: a prospective cohort study","volume":"8","author":"Windisch","year":"2014","journal-title":"Open Orthop J."},{"issue":"7","key":"bib8-20230812","doi-asserted-by":"crossref","first-page":"1239","DOI":"10.1007\/s00264-013-1893-6","article-title":"Clinical and radiological outcomes of treatment of avascular necrosis of the femoral head using autologous osteochondral transfer (mosaicplasty): preliminary report","volume":"37","author":"Gagala","year":"2013","journal-title":"Int Orthop."},{"issue":"6","key":"bib9-20230812","doi-asserted-by":"crossref","first-page":"789","DOI":"10.3928\/01477447-20130523-26","article-title":"Tantalum rod implantation and vascularized iliac grafting for osteonecrosis of the femoral head","volume":"36","author":"Zhao","year":"2013","journal-title":"Orthopedics."},{"issue":"5","key":"bib10-20230812","doi-asserted-by":"crossref","first-page":"1316","DOI":"10.1007\/s11999-009-1159-1","article-title":"Will a vascularized greater trochanter graft preserve the necrotic femoral head?","volume":"468","author":"Zhao","year":"2010","journal-title":"Clin Orthop Relat Res."},{"issue":"10","key":"bib11-20230812","doi-asserted-by":"crossref","first-page":"2819","DOI":"10.1007\/s11999-012-2429-x","article-title":"The vascularized fibular graft in precollapse osteonecrosis: is long-term hip preservation possible?","volume":"470","author":"Eward","year":"2012","journal-title":"Clin Orthop Relat Res."},{"key":"bib12-20230812","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1097\/01.blo.0000181490.31424.96","article-title":"Iliac graft vascularization for femoral head osteonecrosis","volume":"442","author":"Zhao","year":"2006","journal-title":"Clin Orthop Relat Res."}],"container-title":["JBJS Essential Surgical Techniques"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/01709766-201909010-00007","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:35:20Z","timestamp":1787751320000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/01709766-201909010-00007"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,2,13]]},"references-count":12,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2019]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.st.18.00023","relation":{},"ISSN":["2160-2204"],"issn-type":[{"value":"2160-2204","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,2,13]]}}}