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Vascularized Fibular Grafts for Avascular Necrosis After Slipped Capital Femoral Epiphysis: Is Hip Preservation Possible?

  • Symposium: Slipped Capital Femoral Epiphysis: Update and Emerging Concepts
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Avascular necrosis (AVN) of the femoral head is a potential complication in patients with slipped capital femoral epiphysis (SCFE), radiographically occurring in 3–60%. This may lead to early hip fusion or hip arthroplasty. Free vascularized fibular grafting (FVFG) may provide a reasonable means to preserve the femoral head.

Questions/Purposes

We asked: (1) What percentage of patients with AVN after SCFE treated with FVFG underwent subsequent THA or hip fusion and what was the lifespan of the FVFG? (2) Did the graft survival rate of FVFG for AVN after SCFE coincide with historically reported rates of FVFG for idiopathic AVN? And (3) did hip function improve after FVFG?

Methods

We retrospectively reviewed 52 patients who underwent FVFG for SCFE. We calculated the longevity of the graft and factors associated with graft survival. Harris hip scores (HHS) were recorded pre- and postoperatively. Minimum followup was 1 month (median, 19 months; range, 1–136 months).

Results

Five of the 52 patients (10%) underwent conversion to THA (four) or hip fusion (one). Mean age was greater in these patients than in those not requiring further procedures: 16 versus 13 years. Median graft survival time before arthroplasty/fusion was 12 years (range, 2–16 years) while it is currently 8 years (range, 2–16 years) in patients not undergoing subsequent procedures. HHSs improved 35 points on average (38 points preoperatively to 73 points postoperatively).

Conclusions

In patients undergoing FVFG for AVN secondary to SCFE, 90% have maintained their native hips for 8 years with improved hip function, similar to other published reports of FVFG. Further followup is needed of patients currently retaining their FVFGs as to eventual conversion to THA or fusion.

Level of Evidence

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

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Acknowledgments

We thank Jennifer Friend, Clinical Research Coordinator, for her contributions to data collection and review and Cynthia L. Green, PhD, for help with the statistical analysis.

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Authors and Affiliations

  1. Department of Orthopaedics, Duke University Medical Center, DUMC Box 2809, Durham, NC, 27710, USA

    Todd Bertrand MD, James R. Urbaniak MD & Robert K. Lark MD, MS

Authors
  1. Todd Bertrand MD
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  2. James R. Urbaniak MD
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  3. Robert K. Lark MD, MS
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Corresponding author

Correspondence to Robert K. Lark MD, MS.

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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.

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 approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

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Bertrand, T., Urbaniak, J.R. & Lark, R.K. Vascularized Fibular Grafts for Avascular Necrosis After Slipped Capital Femoral Epiphysis: Is Hip Preservation Possible?. Clin Orthop Relat Res 471, 2206–2211 (2013). https://doi.org/10.1007/s11999-012-2781-x

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  • DOI: https://doi.org/10.1007/s11999-012-2781-x

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