HIP ISSN 1120-7000 Hip Int 2017; 27 (1): 74-81 © 2017 Wichtg Publishing ORIGInAL RESEARCH ARTICLE ity of the femoral head, subsequently leading to subchondral bone damage and eventually to inexorable collapse (6, 7). Vari- ous hip preserving procedures have been described (8). These include the standard core decompression (SCD), osteotomies, and either nonvascularised or vascularised bone grafing (9-12). Newer techniques have been recently proposed like the injec- ton of bone marrow aspirate concentrate (BMAC) into the ne- crotc areas in the femoral head (13). As yet, none have been found to be signifcantly associated with superior outcomes, however each aims to forestall the need for THR (14, 15). Early disease was linked with favourable prognosis when head-sparing management optons are utlised (15, 16). Thus, we aim to compare the efcacy of the inverted femoral head grafing (IFHG) to the conventonal evidence-based SCD at minimum 3 years (3-14 years) follow-up in patents sufer- ing from nontraumatc ON of the hip at pre-arthritc stage in terms of postoperatve clinical improvement, decreased need for second surgery and halted radiological signs of progres- sion of the disease. Patents and methods The present study was conducted as a case-controlled, retrospectve study of chart data. Patent privacy and data DOI: 10.5301/hipint.5000426 Inverted femoral head graf versus standard core decompression in nontraumatc hip osteonecrosis at minimum 3 years follow-up Asser A. Sallam 1 , Mohamed A. Imam 1 , Khaled S. Salama 1 , Osman A. Mohamed 2 1 Department of Orthopaedic Surgery and Trauma, Suez Canal University Hospitals, Ismailia - Egypt 2 Department of Orthopaedic Surgery, Al-Azhar University Hospital, Damieta - Egypt Introducton Femoral head osteonecrosis (ON) typically afects young to middle age groups. ON would eventually result in femoral head collapse and joint destructon (1, 2), ultmately requiring prosthetc replacement even when managed at early stages, depending on the size, locaton as well as the progression of the lesion. This pathology accounts for 5 up to 46.9% of total hip replacements (THR) undertaken in younger age groups (3, 4). There is an increased risk (>50%) of bilateral involve- ments in both hips (5). Theoretcally, ON is believed to follow trauma, certain sys- temic diseases, or medicatons that might disrupt the vascular - ABSTRACT Purpose: Numerous salvage surgeries were popularised to halt the progression of hip osteonecrosis (ON). We aimed to compare the clinico-radiological outcomes of inverted femoral head graf (IFHG) versus standard core decompression (SCD) in treatment of nontraumatc hip ON at pre-arthritc stage. Methods: A case review was performed at a minimum 3 years follow-up of 61 patents (71 hips; mean age 32.96 (19-50) years; mean follow-up 7.86 (3-14) years; mean body mass index 28.58 (19-46); 32 males, 29 females) sufering nontraumatc hip ON at pre-arthritc stage. 38 hips underwent SCD and 33 IFHG. The outcome was as- sessed by changes in modifed Harris Hip Score (MHHS), need for revision surgery and progression of modifed Ficat-Arlet staging. Data were analysed including logistc regression and Kaplan-Meier survivorship analysis. Results: 13/34 (38.2%) hips in SCD group were revised at 4.61 ± 2.61 years, while 7/33 (21.2%) in IFHG group at 8.43 ± 4.32 years (p = 0.023). MHHS was signifcantly higher in IFHG group at 1 and 3 years as well as at last follow-up (p = 0.014, 0.001 and 0.023 respectvely). Clinical and radiological signifcant diferences were found in survivorship analysis between both groups, in favor of IFHG. A higher clinical failure was noted among obese patents. Conclusions: An IFHG technique ofers a beter alternatve regarding postoperatve clinico-radiological outcomes in nontraumatc hip ON at the pre-arthritc stage. A cautous prognosis is recommended in obese patents. Keywords: Avascular necrosis, Bone graf, Core decompression, Osteonecrosis Accepted: June 7, 2016 Published online: January 24, 2017 Corresponding author: Asser A. Sallam Department of Orthopedic Surgery and Trauma Suez Canal University Hospitals Kilo 4.5 Ring Road 41111 Ismailia, Egypt assersallam@hotmail.com