Osteonecrosis of the femoral head. A study of 101 hips treated with vascularized fibular grafting.
BACKGROUND
The present study evaluates the minimum five-year results of vascularized fibular grafting for the treatment of osteonecrosis of the femoral head. The purposes of the present study were to review the results of fibular grafting in a large series of patients and to determine the indications for this procedure.


METHODS
Eighty-six patients (101 hips) were followed clinically for a minimum of five years (or until the time of death). The study group included fourteen Marcus-Enneking stage-2 hips, twenty-three stage-3 hips, and sixty-four stage-4 hips. Three patients (three hips) died from unrelated causes before the five-year evaluation, and two patients (two hips) died after the five-year evaluation. Radiographic assessment was performed with use of the Marcus-Enneking grading system, and clinical assessment was performed with use of the Harris hip-scoring system. The end point was conversion to total hip arthroplasty. Patient satisfaction was also assessed.


RESULTS
Sixty-two hips (61%) survived until the time of the five-year follow-up, and forty-two hips (42%) survived until the time of the interview (at a median of eight years postoperatively). The average Harris hip score was 58 +/- 13 at the time of presentation and 80 +/- 15 at five years. Eight (57%) of the Marcus-Enneking stage-2 hips, sixteen (70%) of the stage-3 hips, and thirty-eight (59%) of the stage-4 hips survived for at least five years. Of the eighty-one living patients (including forty-one who had a successful outcome and forty who had had a failure), forty-six patients (including twenty-one who had a successful outcome and twenty-five who had had a failure) stated that they would undergo the procedure again.


CONCLUSIONS
Vascularized fibular grafting may provide a chance for normal hip function in the intermediate or long term in carefully selected patients with osteonecrosis of the femoral head.
Marciniak
Donn
D
The University Hospitals of Cleveland, 11100 Euclid Avenue, Cleveland, OH 44106, USA. dam5@case.edu
Furey
Christopher
C
Shaffer
John W
JW
D000293:Adolescent; D000328:Adult; D019644:Arthroplasty, Replacement, Hip; D016025:Bone Transplantation / Q000379:methods*; D005260:Female; D005271:Femur Head Necrosis / Q000601:surgery*; D005360:Fibula / Q000098:blood supply / Q000637:transplantation*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D012189:Retrospective Studies; D016896:Treatment Outcome