title: Vascularized fibular grafting for osteonecrosis of the femoral head with unusual indications.
abstract: We retrospectively reviewed the charts of 154 patients of various subgroups treated with the free vascularized fibular graft procedure for osteonecrosis of the femoral head (ONFH), evaluating pre- and postoperative Harris hip scores, hip range of motion, radiographs, and number of conversions to total hip arthroplasty (THA). Patients were followed a minimum of 1 year (mean, 6.8 years, range, 1 to 19 years). Athletes and patients with pyarthrosis-related osteonecrosis had high Harris hip scores at final review with scores of 94 and 97, respectively. Patients with ONFH after a slipped capital femoral epiphysis or following pregnancy had a low conversion rate to THA at 6% and 8%, respectively. Twenty-five percent of patients with transplant-related osteonecrosis of the femoral head were converted to THA at an average of 2.7 years. However, with select subsets of patients (athletes, pregnancy, organ transplant, femoral neck non-union, slipped capital femoral epiphysis, infection) the FVFG can result in a high rate of success.
authors: Division of Orthopaedic Surgery, Duke University Medical Center, 3116 North Duke Street, Durham, NC 27704, USA. aldri004@mc.duke.edu
authors: J Mack
authors: JM
authors: Aldridge
authors: James R
authors: JR
authors: Urbaniak
mesh_terms: D000293:Adolescent; D000328:Adult; D001170:Arthritis, Infectious / Q000150:complications / Q000601:surgery; D019645:Arthroplasty, Replacement, Knee; D001265:Athletic Injuries / Q000601:surgery; D016025:Bone Transplantation / Q000009:adverse effects; D002648:Child; D004839:Epiphyses, Slipped / Q000150:complications / Q000601:surgery; D005260:Female; D005265:Femoral Neck Fractures / Q000150:complications / Q000601:surgery; D005270:Femur Head / Q000473:pathology / Q000601:surgery*; D005271:Femur Head Necrosis / Q000209:etiology / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D005500:Follow-Up Studies; D006615:Hip / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D016377:Organ Transplantation / Q000009:adverse effects; D011247:Pregnancy; D011248:Pregnancy Complications / Q000601:surgery; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012086:Reoperation; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome