title: Treatment of osteonecrosis of the femoral head with free vascularized fibular grafting: results of 7.6-year follow-up.
abstract: OBJECTIVE
  The aim of this study was to determine long-term follow-up results of patients with femoral head osteonecrosis who were treated with free vascularized fibular grafting (FVFG).
  
  
  METHODS
  The results of 28 hips of 21 patients (16 male, 5 female) who underwent FVFG for treatment of osteonecrosis of the femoral head were retrospectively reviewed. Mean age of patients at time of surgery was 30.7 years (range: 15-53 years). Mean follow-up duration was 7.6 years (range: 5-9.2 years).
  
  
  RESULTS
  During follow-up, 1 patient died because of leukemia, and 1 patient was lost. The remaining 26 hips of 19 patients were evaluated. According to Ficat classification, at time of surgery, 17 hips were grade II, and 9 hips were grade III, 3 hips underwent total hip arthroplasty. Postoperative Harris Hip Score (HHS) in grade II disease was excellent in 12 patients, good in 3 patients, and fair in 1 patient. In grade III disease, 1 patient was excellent, 5 patients were good, and 1 patient was fair. There was a significant increase in HHS scores from preoperatively to postoperatively (61±9.7 vs 84±17.8, p<0.001).
  
  
  CONCLUSIONS
  FVFG yields extremely good results, particularly in pre-collapse stages of the disease in young patients. The operation time does not markedly increase if the surgical team is knowledgeable of the procedure and the residual fibular defect of the donor site does not impair functions of daily living.
authors.affiliation: Göztepe Medicalpark Hospital, Department of Orthopedics and Traumatology, İstanbul, Turkey.
authors.forename: Mehmet Bekir
authors.initials: MB
authors.lastname: Ünal
authors.affiliation: Marmara University Faculty of Medicine, Department of Orthopedics and Traumatology, İstanbul, Turkey.
authors.forename: Eren
authors.initials: E
authors.lastname: Cansü
authors.affiliation: Yeni Yüzyıl University Faculty of Medicine, Department of Orthopedics and Traumatology, İstanbul, Turkey.
authors.forename: Fatih
authors.initials: F
authors.lastname: Parmaksızoğlu
authors.affiliation: İstanbul Medipol University Faculty of Medicine, Department of Orthopedics and Traumatology, İstanbul, Turkey. hakanturancift@yahoo.com.
authors.forename: Hakan
authors.initials: H
authors.lastname: Çift
authors.affiliation: Private Medicana Hospital, Department of Orthopedics and Traumatology, İstanbul, Turkey.
authors.forename: Serkan
authors.initials: S
authors.lastname: Gürcan
mesh_terms: D000293:Adolescent; D000328:Adult; D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D016025:Bone Transplantation / Q000379:methods*; D005260:Female; D005270:Femur Head / Q000601:surgery*; D005271:Femur Head Necrosis / Q000000981:diagnostic imaging / Q000601:surgery*; D005360:Fibula / Q000637:transplantation*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D014182:Transplantation, Autologous / Q000379:methods; D016896:Treatment Outcome; D014421:Turkey; D055815:Young Adult