Free vascularized fibular grafting for the treatment of postcollapse osteonecrosis of the femoral head

The Journal of Bone and Joint Surgery. American Volume
Keith R BerendJames R Urbaniak

Abstract

Osteonecrosis of the femoral head, a disease primarily affecting young adults, is often associated with collapse of the articular surface and subsequent arthrosis. Free vascularized fibular grafting has been reported to be successful for patients with early stages of osteonecrosis, but little is known about its efficacy after the femoral head has collapsed. We retrospectively reviewed the results in a consecutive series of 188 patients (224 hips) who had undergone free vascularized fibular grafting, between 1989 and 1999, for the treatment of osteonecrosis of the hip that had led to collapse of the femoral head but not to arthrosis. The average duration of follow-up was 4.3 years (range, two to twelve years). We defined conversion to total hip arthroplasty as the failure end point, and we analyzed the contribution, to failure, of the size of the lesion, amount of preoperative collapse of the femoral head, etiology of the osteonecrosis, age of the patient, and bilaterality of the lesion. We used the Harris hip score to evaluate clinical status preoperatively and at the time of the most recent follow-up. The overall rate of survival was 67.4% for the hips followed for a minimum of two years and 64.5% for those followed for a mini...Continue Reading

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