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Long-term Followup of Vascularized Fibular Grafting for Femoral Head Necrosis

  • Symposium: Molecular and Surgical Advances in Osteonecrosis
  • Published:
Clinical Orthopaedics and Related Research

Abstract

Vascularized fibular grafting has been used for treatment of osteonecrosis of the femoral head and although some reports demonstrate successful short- to mid-term outcomes, long-term results are still unknown. We retrospectively reviewed 135 patients (151 hips) who underwent vascularized fibular grafting for osteonecrosis of the femoral head. One-hundred and ten patients (124 hips) were followed for a minimum 10 years (mean, 13.9 years; range, 10–23.7 years). The mean Harris hip score improved from 72 to 88. At the latest followup, we found improved or unchanged radiographs in 37 of 59 hips initially Stage II hips and 39 of 65 Stage III hips. Thirteen hips (13 patients) (10.5%) failed treatment and underwent total hip arthroplasty. The location and size of the necrotic lesion and the patient’s age influenced long-term survival of the graft. Postoperative complications included clawing of the big toe in 17 patients, partial peroneal nerve palsy in two, and superficial infection in two. Subtrochanteric fracture occurred in two hips. The data suggest free vascularized fibular grafting was successful in maintaining joint function and delaying the need for joint replacement procedure. Graft survival was associated with the patient’s age and size and location of the lesion but not etiology and stages of the disease.

Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

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References

  1. Aaron RK. Treatment of osteonecrosis of the femoral head with electrical stimulation. Instr Course Lect. 1994;43:495–498.

    PubMed  CAS  Google Scholar 

  2. Arai K, Toh S, Tsubo K, Nishikawa S, Narita S, Miura H. Complications of vascularized fibula graft for reconstruction of long bones. Plast Reconstr Surg. 2002;1097:2301–2306.

    Article  Google Scholar 

  3. Berend KR, Gunneson E, Urbaniak JR, Vail TP. Hip arthroplasty after failed free vascularized fibular grafting for osteonecrosis in young patients. J Arthroplasty. 2003;184:411–419.

    Article  Google Scholar 

  4. Berend KR, Gunneson EE, Urbaniak JR. Free vascularized fibular grafting for the treatment of postcollapse osteonecrosis of the femoral head. J Bone Joint Surg Am. 2003;85:987–993.

    PubMed  Google Scholar 

  5. Brunelli G, Brunelli G. Free microvascular fibular transfer for idiopathic femoral head necrosis: long-term follow-up. J Reconstr Microsurg. 1991;7:285–295.

    Article  PubMed  CAS  Google Scholar 

  6. Chillag KJ. Survival analysis of hips treated with core decompression or vascularized fibular grafting because of avascular necrosis. J Bone Joint Surg Am. 2000;82:289–290.

    PubMed  CAS  Google Scholar 

  7. Cho BC, Kim SY, Lee JH, Ramasastry SS, Weinzweig N, Baik BS. Treatment of osteonecrosis of the femoral head with free vascularized fibular transfer. Ann Plast Surg. 1998;40:586–593.

    Article  PubMed  CAS  Google Scholar 

  8. Dean GS, Kime RC, Fitch RD, Gunneson E, Urbaniak JR. Treatment of osteonecrosis in the hip of pediatric patients by free vascularized fibular graft. Clin Orthop Relat Res. 2001;386:106–113.

    Article  PubMed  Google Scholar 

  9. Ficat P, Arlet J, Vidal R, Ricci A, Fournial JC. Therapeutic results of drill biopsy in primary osteonecrosis of the femoral head (100 cases) [in French]. Rev Rhum Mal Osteoartic. 1971;38:269–276.

    PubMed  CAS  Google Scholar 

  10. Garberina MJ, Berend KR, Gunneson EE, Urbaniak JR. Results of free vascularized fibular grafting for femoral head osteonecrosis in patients with systemic lupus erythematosus. Orthop Clin North Am. 2004;353:353–357.

    Article  Google Scholar 

  11. Gonzalez Della Valle A, Bates J, Di Carlo E, Salvati EA. Failure of free vascularized fibular graft for osteonecrosis of the femoral head: a histopathologic study of 6 cases. J Arthroplasty. 2005;203:331–336.

    Article  Google Scholar 

  12. Goodman SB. Survival analysis of hips treated with core decompression or vascularized fibular grafting because of avascular necrosis. J Bone Joint Surg Am. 2000;82:289.

    PubMed  CAS  Google Scholar 

  13. Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am. 1969;51:737–755.

    PubMed  CAS  Google Scholar 

  14. Judet H, Gilbert A. Long-term results of free vascularized fibular grafting for femoral head necrosis. Clin Orthop Relat Res. 2001;386:114–119.

    Article  PubMed  Google Scholar 

  15. Kane SM, Ward WA, Jordan LC, Guilford WB, Hanley EN Jr. Vascularized fibular grafting compared with core decompression in the treatment of femoral head osteonecrosis. Orthopedics. 1996;19:869–872.

    PubMed  CAS  Google Scholar 

  16. Kim SY, Kim YG, Kim PT, Ihn JC, Cho BC, Koo KH. Vascularized compared with nonvascularized fibular grafts for large osteonecrotic lesions of the femoral head. J Bone Joint Surg Am. 2005;879:2012–2018.

    Article  Google Scholar 

  17. Louie BE, McKee MD, Richards RR, Mahoney JL, Waddell JP, Beaton DE, Schemitsch EH, Yoo DJ. Treatment of osteonecrosis of the femoral head by free vascularized fibular grafting: an analysis of surgical outcome and patient health status. Can J Surg. 1999;42:274–283.

    PubMed  CAS  Google Scholar 

  18. Malizos KN, Quarles LD, Dailiana ZH, Rizk WS, Seaber AV, Urbaniak JR. Analysis of failures after vascularized fibular grafting in femoral head necrosis. Orthop Clin North Am. 2004;353:305–314.

    Article  Google Scholar 

  19. Malizos KN, Soucacos PN, Beris AE. Osteonecrosis of the femoral head. Hip salvaging with implantation of a vascularized fibular graft. Clin Orthop Relat Res. 1995;314:67–75.

    PubMed  Google Scholar 

  20. Marciniak D, Furey C, Shaffer JW. Osteonecrosis of the femoral head. A study of 101 hips treated with vascularized fibular grafting. J Bone Joint Surg Am. 2005;874:742–747.

    Article  Google Scholar 

  21. Marcus ND, Enneking WF, Massam RA. The silent hip in idiopathic aseptic necrosis. Treatment by bone-grafting. J Bone Joint Surg Am. 1973;55:1351–1366.

    PubMed  CAS  Google Scholar 

  22. Mont MA, Jones LC, Einhorn TA, Hungerford DS, Reddi AH. Osteonecrosis of the femoral head. Potential treatment with growth and differentiation factors. Clin Orthop Relat Res. 1998;355(Suppl):S314–S335.

    Article  PubMed  Google Scholar 

  23. Mont MA, Jones LC, Hungerford DS. Survival analysis of hips treated with core decompression or vascularized fibular grafting because of avascular necrosis. J Bone Joint Surg Am. 2000;82:290–291.

    Article  PubMed  CAS  Google Scholar 

  24. Mulliken BD. Osteonecrosis of the femoral head: current concepts and controversies. Iowa Orthop J. 1993;13:160–166.

    PubMed  CAS  Google Scholar 

  25. Nishii T, Sugano N, Ohzono K, Sakai T, Haraguchi K, Yoshikawa H. Progression and cessation of collapse in osteonecrosis of the femoral head. Clin Orthop Relat Res. 2002;400:149–157.

    Article  PubMed  Google Scholar 

  26. Nishii T, Sugano N, Ohzono K, Sakai T, Sato Y, Yoshikawa H. Significance of lesion size and location in the prediction of collapse of osteonecrosis of the femoral head: a new three-dimensional quantification using magnetic resonance imaging. J Orthop Res. 2002;201:130–136.

    Article  Google Scholar 

  27. Ohzono K, Saito M, Takaoka K, Ono K, Saito S, Nishina T, Kadowaki T. Natural history of nontraumatic avascular necrosis of the femoral head. J Bone Joint Surg Br. 1991;73:68–72.

    PubMed  CAS  Google Scholar 

  28. Plakseychuk AY, Kim SY, Park BC, Varitimidis SE, Rubash HE, Sotereanos DG. Vascularized compared with nonvascularized fibular grafting for the treatment of osteonecrosis of the femoral head. J Bone Joint Surg Am. 2003;85:589–596.

    PubMed  Google Scholar 

  29. Plancher KD, Razi A. Management of osteonecrosis of the femoral head. Orthop Clin North Am. 1997;283:461–477.

    Article  Google Scholar 

  30. Scully SP, Aaron RK, Urbaniak JR. Survival analysis of hips treated with core decompression or vascularized fibular grafting because of avascular necrosis. J Bone Joint Surg Am. 1998;80:1270–1275.

    PubMed  CAS  Google Scholar 

  31. Soucacos PN, Beris AE, Malizos K, Koropilias A, Zalavras H, Dailiana Z. Treatment of avascular necrosis of the femoral head with vascularized fibular transplant. Clin Orthop Relat Res. 2001;386:120–130.

    Article  PubMed  Google Scholar 

  32. Springfield DS, Enneking WJ. Surgery for aseptic necrosis of the femoral head. Clin Orthop Relat Res. 1978;130:175–185.

    PubMed  Google Scholar 

  33. Steinberg ME, Bands RE, Parry S, Hoffman E, Chan T, Hartman KM. Does lesion size affect the outcome in avascular necrosis? Clin Orthop Relat Res. 1999;367:262–271.

    Article  PubMed  Google Scholar 

  34. Steinberg ME, Brighton CT, Corces A, Hayken GD, Steinberg DR, Strafford B, Tooze SE, Fallon M. Osteonecrosis of the femoral head. Results of core decompression and grafting with and without electrical stimulation. Clin Orthop Relat Res. 1989;249:199–208.

    PubMed  Google Scholar 

  35. Steinberg ME, Brighton CT, Hayken GD, Tooze SE, Steinberg DR. Electrical stimulation in the treatment of osteonecrosis of the femoral head—a 1-year follow-up. Orthop Clin North Am. 1985;16:747–756.

    PubMed  CAS  Google Scholar 

  36. Steinberg ME, Brighton CT, Steinberg DR, Tooze SE, Hayken GD. Treatment of avascular necrosis of the femoral head by a combination of bone grafting, decompression, and electrical stimulation. Clin Orthop Relat Res. 1984;186:137–153.

    PubMed  Google Scholar 

  37. Steinberg ME, Hayken GD, Steinberg DR. A quantitative system for staging avascular necrosis. J Bone Joint Surg Br. 1995;77:34–41.

    PubMed  CAS  Google Scholar 

  38. Steinberg ME, Larcom PG, Strafford B, Hosick WB, Corces A, Bands RE, Hartman KE. Core decompression with bone grafting for osteonecrosis of the femoral head. Clin Orthop Relat Res. 2001;386:71–78.

    Article  PubMed  Google Scholar 

  39. Sugano N, Atsumi T, Ohzono K, Kubo T, Hotokebuchi T, Takaoka K. The 2001 revised criteria for diagnosis, classification, and staging of idiopathic osteonecrosis of the femoral head. J Orthop Sci. 2002;75:601–605.

    Article  Google Scholar 

  40. Sugano N, Takaoka K, Ohzono K, Matsui M, Masuhara K, Ono K. Prognostication of nontraumatic avascular necrosis of the femoral head. Significance of location and size of the necrotic lesion. Clin Orthop Relat Res. 1994;303:155–164.

    PubMed  Google Scholar 

  41. Sugioka Y, Hotokebuchi T, Tsutsui H. Transtrochanteric anterior rotational osteotomy for idiopathic and steroid-induced necrosis of the femoral head. Indications and long-term results. Clin Orthop Relat Res. 1992;277:111–120.

    PubMed  Google Scholar 

  42. Trancik T, Lunceford E, Strum D. The effect of electrical stimulation on osteonecrosis of the femoral head. Clin Orthop Relat Res. 1990;256:120–124.

    PubMed  Google Scholar 

  43. Urbaniak JR, Coogan PG, Gunneson EB, Nunley JA. Treatment of osteonecrosis of the femoral head with free vascularized fibular grafting. A long-term follow-up study of one hundred and three hips. J Bone Joint Surg Am. 1995;77:681–694.

    PubMed  CAS  Google Scholar 

  44. Yoo MC, Chung DW, Hahn CS. Free vascularized fibula grafting for the treatment of osteonecrosis of the femoral head. Clin Orthop Relat Res. 1992;277:128–138.

    PubMed  Google Scholar 

  45. Zhang C, Zeng B, Xu Z, Sui S, Song W, Jin D, Shi H, Wang K. Treatment of osteonecrosis of femoral head with free vascularized fibula grafting [in Chinese]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2004;18:367–369.

    PubMed  Google Scholar 

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Acknowledgment

We thank Dr. Sung-Woo Park for the radiographic assessment.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Center for Joint Diseases, East-West Neo Medical Center, Kyung Hee University, 149 Sangil-dong, Gangdong-gu, Seoul, 134-727, Korea

    Myung-Chul Yoo MD, PhD & Kang-Il Kim MD, PhD

  2. Department of Orthopaedic Surgery, Kyung Hee Medical Center, Kyung Hee University, 1 Haegi-dong, Dongdaeman-gu, Seoul, 130-702, Korea

    Chung-Soo Hahn MD, PhD

  3. Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA

    Javad Parvizi MD

Authors
  1. Myung-Chul Yoo MD, PhD
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  2. Kang-Il Kim MD, PhD
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  3. Chung-Soo Hahn MD, PhD
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Correspondence to Myung-Chul Yoo MD, PhD.

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Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution either has waived or does not require approval for the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

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Yoo, MC., Kim, KI., Hahn, CS. et al. Long-term Followup of Vascularized Fibular Grafting for Femoral Head Necrosis. Clin Orthop Relat Res 466, 1133–1140 (2008). https://doi.org/10.1007/s11999-008-0204-9

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  • DOI: https://doi.org/10.1007/s11999-008-0204-9

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