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 of the patients who had femoral head osteonecrosis and had been treated with free vascularized fibular grafting.
  
  
  METHODS
  We retrospectively reviewed 28 hips of 21 patients who had undergone free vascularized fibular grafting for the treatment of osteonecrosis of femoral head. There were 16 male and 5 female patients. The mean age of the patients at the time of surgery was 30.7 years (between 15 and 53 years). The mean follow-up time was 7.6 years (between 5 years and 9.2 years).
  
  
  RESULTS
  During follow-up, one patient died because of leukemia, and one patient was lost. The remaining 26 hips of 19 patients were evaluated. According to the Ficat classification, at the time of surgery, 17 hips were in grade 2 and 9 hips were in grade 3. The post-operative Harris hip scores in grade II disease were 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 (61 ± 9.7 vs 84 ± 17.8, p < 0.001).
  
  
  CONCLUSIONS
  Free vascularized fibular grafting yields extremely good results, particularly in pre-collapse stages of disease in young patients. The operation time does not mark increased if the surgical team is "familiar" with the procedure, and the residual fibular defect of the donor site does not impair the functions of daily living.
  
  
  METHODS
  Level IV, Therapeutic study.
authors.affiliation: Göztepe Medicalpark Hospital, İstanbul, Turkey.
authors.forename: Mehmet Bekir
authors.initials: MB
authors.lastname: Ünal
authors.affiliation: Marmara University School of Medicine, Turkey.
authors.forename: Eren
authors.initials: E
authors.lastname: Cansu
authors.affiliation: Yeni Yüzyıl University School of Medicine, Turkey.
authors.forename: Fatih
authors.initials: F
authors.lastname: Parmaksızoğlu
authors.affiliation: Istanbul Medipol Universitesi Istanbul, Istanbul, Turkey. Electronic address: hakanturancift@yahoo.com.
authors.forename: Hakan
authors.initials: H
authors.lastname: Cift
authors.affiliation: Private Medicana Hospital, Turkey.
authors.forename: Serkan
authors.initials: S
authors.lastname: Gürcan
mesh_terms: D000293:Adolescent; D000328:Adult; 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; D055815:Young Adult
keywords: Free vascularized fibular grafting; Osteonecrosis of the femoral head