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The Vascularized Fibular Graft in Precollapse Osteonecrosis: Is Long-term Hip Preservation Possible?

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Osteonecrosis of the femoral head (ONFH) is a debilitating condition affecting primarily young patients. Free vascularized fibular grafting (FVFG) may provide a durable means to preserve the femoral head. When used in the precollapse stages of ONFH, this treatment may alter the course of disease.

Questions/purposes

We asked: (1) In what percentage of patients does FVFG preserve the femoral head beyond 10 years? (2) When long-term preservation is not achieved, what is the duration of femoral head preservation? (3) Do demographic or etiologic factors predict FVFG survivorship? (4) What long-term improvements in function and activity can be anticipated?

Methods

We retrospectively reviewed 61 patients (65 hips) who underwent FVFG for precollapse ONFH. We calculated graft survivorship, SF-12 scores, activity levels, and Harris hip scores. Minimum followup was 10.5 years (mean, 14.4 years; range, 10.5–26 years).

Results Forty-nine of 65 hips (75%) had surviving FVFG for at least 10 years. At last followup, 39 of 65 hips (60%) had surviving FVFG, with a mean graft survival time of 15 years (range, 10.5–26.1 years). Twenty-six of the 65 hips with FVFG (40%) underwent conversion to THA at a mean of 8 years postoperatively. Demographic factors, lesion size, additional procedures, and low preoperative function were not associated with changes in graft survivorship. Pain and function were similar in patients with surviving FVFG and patients who had conversion to THA. Patients with surviving FVFG were more likely to engage in impact sports or active events than were patients who had conversion to THA.

Conclusions

When patients with precollapse ONFH undergo FVFG, the majority have preservation of the hip lasting for greater than 10 years with low levels of pain and reasonable function. In patients who ultimately undergo conversion surgery to THA, the mean duration of hip preservation before conversion is 8 years. We continue to use FVFG for treating patients younger than 50 years with symptomatic, precollapse ONFH.

Level of Evidence

Level IV, therapeutic study. See Instructions to Authors for a complete description of levels of evidence.

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Acknowledgments

We thank Mack Aldridge (JMA) MD for his dedicated care given to many of the patients included in this analysis, to Sandra Stinnett for statistical analysis of data, and to Jennifer Friend for her invaluable contributions to data collection and review.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Duke University Medical Center, Box 3000, Orange Zone, Durham, NC, 27710, USA

    William C. Eward DVM, MD, James R. Urbaniak MD, Marc J. Richard MD & David S. Ruch MD

  2. Wilmington Orthopaedic Group, Wilmington, NC, USA

    Craig A. Rineer MD

Authors
  1. William C. Eward DVM, MD
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  2. Craig A. Rineer MD
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  3. James R. Urbaniak MD
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  4. Marc J. Richard MD
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  5. David S. Ruch MD
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Corresponding author

Correspondence to William C. Eward DVM, MD.

Additional information

Each author certifies that he or she, or a member of his or her immediate family, 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.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution has approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This work was performed at Duke University Medical Center, Durham, NC, USA.

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Eward, W.C., Rineer, C.A., Urbaniak, J.R. et al. The Vascularized Fibular Graft in Precollapse Osteonecrosis: Is Long-term Hip Preservation Possible?. Clin Orthop Relat Res 470, 2819–2826 (2012). https://doi.org/10.1007/s11999-012-2429-x

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