Necrosis of the Femoral Head in Adults: Repair After Coring and Autogenous Tibial Bone Grafting (Phemister Technique)

Twenty-six femoral heads with aseptic necrosis which had been treated by the Phemister technique (coring and tibial bone grafting), and two femoral heads treated with coring and a single graft were excised at reconstructive surgery and studied histologically. The twenty-eight heads of the femur were removed from nine months to twenty-eight years post grafting. The histologic repair of the necrotic femoral head and the autogenous tibial bone graft, was evaluated. Repair of the femoral head, although not complete at one year, was usually complete by five years, and included the necrotic subchondral cortex. The grafts were gradually converted to cancellous bone, and in some cases, appeared to give structural support to the necrotic segment.