title: Treatment of osteonecrosis of the femoral head with free vascularized fibular transfer.
abstract: Thirty-one free vascularized fibular bone grafts were performed for treatment of osteonecrosis of the femoral head in 26 patients. Twenty-four men and 2 women ranged in age from 16 to 48 years (mean, 32 years). Twenty-one patients had unilateral disease. Five patients had bilateral disease and underwent staged bilateral free vascularized fibular grafts 3 months apart. Associated etiological factors included alcohol (9 patients), steroid use (7 patients), and trauma (1 patient). The condition was considered idiopathic in the remaining 9 patients. Radiological staging by Ficat included stage I in 1 hip, stage II in 15 hips, stage III in 14 hips, and stage IV in 1 hip. A skin island flap was used for monitoring purposes to check the patency of blood flow to the grafted fibula. One flap failed by venous occlusion and was left as a nonvascularized bone graft. Thirty hips were followed. Pain was relieved in 28 hips (93.3%) and aggravated in 2 hips (6.7%). On radiographic evaluation, 26 hips (86.7%) demonstrated excellent preservation of the femoral head contour. Progressive collapse of the femoral head (>1-2 mm) occurred in two hips, with 1-mm depression in one hip with stage III disease and 2-mm collapse in one hip with stage IV disease. Follow-up ranged from 12 to 40 months (mean, 21 months). In conclusion, even in this relatively short follow-up period, the free vascularized fibular bone graft is an excellent treatment modality for preserving the femoral head and relieving symptoms in patients with osteonecrosis of the femoral head.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Kyungpook National University Hospital, Taegu, Korea.
authors.forename: B C
authors.initials: BC
authors.lastname: Cho
authors.forename: S Y
authors.initials: SY
authors.lastname: Kim
authors.forename: J H
authors.initials: JH
authors.lastname: Lee
authors.forename: S S
authors.initials: SS
authors.lastname: Ramasastry
authors.forename: N
authors.initials: N
authors.lastname: Weinzweig
authors.forename: B S
authors.initials: BS
authors.lastname: Baik
mesh_terms: D000293:Adolescent; D000328:Adult; D016025:Bone Transplantation / Q000379:methods* / Q000502:physiology; D018450:Disease Progression; D005260:Female; D005271:Femur Head Necrosis / Q000000981:diagnostic imaging / Q000601:surgery*; D005360:Fibula / Q000637:transplantation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D016896:Treatment Outcome