title: Free vascularized fibular grafting benefits severely collapsed femoral head in concomitant with osteoarthritis in very young adults: a prospective study.
abstract: Although free vascularized fibular grafting (FVFG) has been successfully employed for precollapsed osteonecrosis of the femoral head (ONFH), there are few reports concerning its radiographic and functional results for ONFH concomitant with osteoarthritis (OA) of the hip. In the current study, 12 patients with OA induced by traumatic ONFH were enrolled, with FVFG employed as the treatment protocol. The collapsed step of the cartilage surface was measured and compared with the postoperative value, and the Merle d'Aubigné scoring system was used to evaluate preoperative and postoperative status of the hip joint. The collapsed step disappeared, and sphericity of the femoral head could be restored at an average duration of 56 months postoperatively in seven patients. With regard to the severity of hip OA, six were improved to Grade 1 and one to Grade 2. In terms of functionality, all patients with a restored femoral head experienced postoperative improvement in pain relief, mobility, and functional capacity. The average Merle d'Aubigné score increased from 6.0 to 16.9 postoperatively (p < 0.001). In conclusion, for traumatic ONFH concomitant with OA, FVFG can confer benefits in the form of restoration of the contour of the femoral head and improvement in joint function.
authors.affiliation: Department of Orthopedic Surgery, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China.
authors.forename: Hao
authors.initials: H
authors.lastname: Ding
authors.forename: You-Shui
authors.initials: YS
authors.lastname: Gao
authors.forename: Sheng-Bao
authors.initials: SB
authors.lastname: Chen
authors.forename: Dong-Xu
authors.initials: DX
authors.lastname: Jin
authors.forename: Chang-Qing
authors.initials: CQ
authors.lastname: Zhang
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D016025:Bone Transplantation / Q000009:adverse effects / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D005271:Femur Head Necrosis / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D005360:Fibula / Q000098:blood supply* / Q000637:transplantation; D005500:Follow-Up Studies; D058752:Free Tissue Flaps / Q000098:blood supply*; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D008297:Male; D015207:Osteoarthritis, Hip / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D010147:Pain Measurement; D011446:Prospective Studies; D016059:Range of Motion, Articular / Q000502:physiology; D020127:Recovery of Function; D018570:Risk Assessment; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult