To evaluate the outcome of the single way of the great trochanter with double hole core decompression and bone impaction grafting + allogeneic fibula support for the treatment of early stages of osteonecrosis of the femoral head(ONFH).

From March 2011 to March 2017, totally 30 cases (41 hip) of early ONFH were treated with the modified Phemister Procedure "single way of the great trochanter with double hole core decompression and bone impaction grafting + allogeneic fibula support" in Department of Orthopaedic, Beijing Jishuitan Hospital. All patients underwent bilateral anteroposterior and lateral hip joint X-ray, CT plain scan and MRI before surgery. The Harris hip score was used to evaluate the hip joint function before operation. Pre-operation according to the Association Research Circulation Osseous(ARCO) system, 1 hip was graded for stage ARCO ⅡA, 1 was graded hip for stage ARCO ⅡB, 33 hip was graded for stage ARCO ⅡC, and 6 hip was graded for stage ARCO ⅢC. Anteroposterior and lateral X-rays and CT were used to evaluate the imaging progress. The Harris hip score was also used to evaluate the hip joint function at the latest follow-up. The data were analyzed by paired t-test and chi-square test.

All patients were followed up for an average of (33.6±13.2) months. The average Harris hip score was changed from (74.2±5.8) points before surgery to (87.7±7.2) points at the latest follow-up. The rate of excellent and good was changed from 12.20% before surgery to 80.49% at the latest follow-up, the differences were statistically significant(t=3.129, χ²=38.45; with P values below 0.05). Among them, 1 case of women with stage ARCO Ⅱ on the left side hip joint before surgery, underwent total hip replacement in 22 months after surgery; 2 cases with 3 for ARCO ⅡC, had progression to stage Ⅲ at the time of last follow-up, but the hip joint function was good. At the time of last follow-up the surgery success rate was 97.56%.

The modified Phemister Procedure "single way of the great trochanter with double hole core decompression and bone impaction grafting + allogeneic fibula support" is an effective method to treat early stage of ONFH. The method has the following advantages: small surgical trauma, fast recovery, fewer complications and good clinical effect..