Free Vascularized Fibular Grafting Following Failed Core Decompression for Femoral Head Osteonecrosis

Dailiana, Zoe; Toth, Alison P.; Gunneson, Eunice E.; Berend, Keith R.; Urbaniak, James R.

doi:10.1016/j.arth.2006.12.042

Cited by 24 publications

(24 citation statements)

References 70 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Numerous procedures have been proposed to treat this condition, including core decompression [1,6,18,19,24,29,47,49,58,63], vascularized grafts [3,5,7,8,20,27,28,30,39,50,61,66], and osteotomy [2,9,16,17,23,40,44,45,62]. The term ''core decompression'' represents a spectrum of procedures that may include one large core tract or multiple small tracts [25,32].…”

Section: Introductionmentioning

confidence: 99%

“…The term ''core decompression'' represents a spectrum of procedures that may include one large core tract or multiple small tracts [25,32]. Additionally, core decompression may be supplemented with a vascularized [3,5,7,8,20,27,28,30,39,50,61,66] or nonvascularized graft [21,29,34,46,52,64] or with electrical stimulation [52]. Marker et al [33] compared the core decompression procedures before 1992 and between 1992 and 2007 and found patients with collapse of the femoral head often have progression of disease after a femoral head-saving procedure.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Which Factors Influence Preservation of the Osteonecrotic Femoral Head?

Lieberman

Engstrom

Meneghini

et al. 2012

Clinical Orthopaedics &Amp; Related Research

142

108

View full text Add to dashboard Cite

show abstract

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Which Factors Influence Preservation of the Osteonecrotic Femoral Head?

Lieberman

Engstrom

Meneghini

et al. 2012

Clinical Orthopaedics &Amp; Related Research

142

108

View full text Add to dashboard Cite

show abstract

“…Middle to late stage ONFH usually cannot acquire satisfactory results for both surgeons and patients, resulting in the view that most researchers [24][25][26] consider THA surgery as the last treatment. However, as ONFH patients become increasingly younger, a proper and improved hippreserving approach with clinical efficacy seems extremely important and urgently needed.…”

Section: Introductionmentioning

confidence: 99%

Vascularised greater trochanter bone graft, combined free iliac flap and impaction bone grafting for osteonecrosis of the femoral head

Zeng

He²,

Feng³

et al. 2013

International Orthopaedics (SICOT)

View full text Add to dashboard Cite

Purpose To investigate the curative efficacy of osteonecrosis of the femoral head (ONFH) in a hip-preserving operative approach, by grafting a vascularized greater trochanter flap combined with a free iliac flap, in an attempt to seek an innovative approach for patients who suffered middle to late stage ONFH without total hip arthroplasty (THA) surgery. Method Our research included a total of 60 patients (66 hips) who accepted hip-preserving surgery by grafting a vascularized greater trochanter flap combined with a free iliac flap which was tightly filled by hammering because of ONFH (most were Association Research Circulation Osseous (ARCO) stage III patients) from January, 2006 to December, 2010. A Harris Hip Score was obtained during follow-ups, evaluating the clinical efficacy, X-rays were taken regularly for image assessing, and the SF-36 scale was used for estimating quality of life. Terminal observation time was considered when patients had symptom-dependant indications for performing another hip-preserving surgery or THA surgery. Results Fifty-eight patients (64 hips) were eventually contacted by telephone for an out-patient clinic return visit, with a mean follow-up time of 35.8 months (varied from 12 months to 60 months), but two patients lost contact for various reasons. The demographic data were as follows: there were 16 ARCO IIIA cases, 22 ARCO IIIB cases, and 26 ARCO IIIC cases, respectively. Postoperative X-rays revealed a well-repaired necrotic area of the femoral head and improvement of femoral-acetabulum coverage. The last follow-up mean Harris Hip Score was 86.56±7.38 (excellent results reached 87.50 %), which were greatly improved compared to 50.95±6.86 pre-operatively. Also the postoperative mean scores of all dimensions of the SF-36 scale were improved to some extent. Additionally the physical component summary (PSC) scores were enhanced from 42± 13 pre-operatively to 78±11, while the postoperative mental component summary (MCS) scores (76±11) largely increased in contrast to pre-operative scores (51±10), with both target indices having statistical significance (p=0.005, p=0.01), signifying hugely improvement of the quality of life of the patients. A correlation was found between Harris Hip Score and all dimensions of SF-36 scale (r=0.32-0.72), especially closely correlated with physical functioning (PF), role-physical (RP) and bodily pain (BP) in PCS aspect (r= 0.72, p < 0.01; r = 0.58, p < 0.01; r = 0.65, p < 0.01, respectively). Conclusion There is definite curative efficacy for the treatment of ONFH with an hip-preserving operative approach by grafting a vascularized greater trochanter flap combined with a free iliac flap which was tightly filled by hammering. This kind of operative approach reconstructs the biological stability of femoral head, which promotes repair of necrotic areas and indirectly preserves the femoral head of patients and a majority of hip function. It possesses vast clinical as well as practical significance, because the long-term efficacy can satisfy fundam...

show abstract

“…The most frequently employed system was that of Ficat and Arlet [2] which was used in 96 studies. The next most common were the University of Pennsylvania (UPenn) system [3-5] used in 31 studies, the Association Research Circulation Osseous (ARCO) system [6][7][8] used in 18 studies and the system of the Japanese Orthopaedic Association [9,10] used in seven studies. During this period, nonquantitative methods of classification were cited 109 times (62 %), quantitative systems were cited 50 times (29 %) and systems which included limited methods of quantification were cited 16 times (9 %).…”

Section: Resultsmentioning

confidence: 99%

“…In 1987, the Japanese Committee for Avascular Necrosis described a radiographic classification which indicated the location and type of lesion in stages II and III of the Ficat and Arlet classification [9]. This was subsequently modified to include stages I and IV in 2001 [10].…”

Section: Discussionmentioning

confidence: 99%

Are we evaluating osteonecrosis adequately?

Lee

Steinberg

2012

International Orthopaedics (SICOT)

View full text Add to dashboard Cite

Purpose It is well recognised that to evaluate a patient with osteonecrosis of the femoral head (ONFH) adequately, it is necessary that the size of the infarct and the extent of femoral head joint involvement be indicated, in addition to the type or stage of the pathological process. The purpose of this study was to determine whether patients with ONFH are being evaluated adequately in studies published during the past 25 years and to see if any trends can be identified. Methods Articles describing treatment of patients with ONFH, published between 1985 and 2011, were reviewed to determine the methods used to indicate the type and extent of pathology present on radiographs and magnetic resonance imaging (MRI) studies. The classification systems cited were identified and divided between those which indicated only the stage and those which indicated both stage and extent of involvement. Results In 208 studies published between 1985 and 2011, specific classification systems were cited 237 times. During this period, non-quantitative systems, which only indicate stage, were cited 139 times (59 %) and quantitative systems, which indicate both stage and extent of involvement were cited 77 times (32 %). Between 2006 and 2011, nonquantitative systems were cited 30 times (48 %) and quantitative systems were cited 27 times (44 %). Conclusions During the past 25 years there has been a trend towards the use of more comprehensive and effective methods of evaluating patients with ONFH. However, during the past five years, approximately half of the published studies continued to use limited, non-quantitative methods of evaluation. This should be brought to the attention of the orthopaedic community. Future investigations and publications on ONFH should employ comprehensive methods of classification which include not only the stage of disease but also measurements of the size of the necrotic segment and the extent of femoral head and joint involvement.

show abstract

Free Vascularized Fibular Grafting Following Failed Core Decompression for Femoral Head Osteonecrosis

Cited by 24 publications

References 70 publications

Which Factors Influence Preservation of the Osteonecrotic Femoral Head?

Which Factors Influence Preservation of the Osteonecrotic Femoral Head?

Vascularised greater trochanter bone graft, combined free iliac flap and impaction bone grafting for osteonecrosis of the femoral head

Are we evaluating osteonecrosis adequately?

Contact Info

Product

Resources

About