Free Vascularized Fibular Grafting for the Treatment of Postcollapse Osteonecrosis of the Femoral Head

Aldridge, J. Mack; Berend, Keith R.; Gunneson, Eunice E.; Urbaniak, James R.

doi:10.2106/00004623-200403001-00012

Cited by 68 publications

(22 citation statements)

References 4 publications

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“…We sought to better define the typical long-term results after FVFG specifically in patients with precollapse ONFH. In so doing, we sought to answer four specific questions: (1) In what percentage of patients does FVFG preserve the precollapse femoral head beyond 10 years? (2) When longterm preservation of the femoral head is not achieved, what is the duration of femoral head preservation?…”

Section: Discussionmentioning

confidence: 99%

“…A technique previously described in detail [1] was used for all procedures. Several technical modifications have been made during the years and were used in our study.…”

Section: Methodsmentioning

confidence: 99%

“…There are multiple such treatment options directed toward preserving the femoral head and maintaining coxofemoral joint congruity to prevent or delay hip arthrosis [2,9]. Although technically complex, treatment by free vascularized fibular grafting (FVFG) is reportedly a biologic option for hip preservation that may last 20 years or longer [1,2,7,9,13,28]. It generally is accepted this intervention is more likely to result in hip preservation when performed before radiographic collapse of the femoral head [1,2,9,20,26].…”

Section: Introductionmentioning

confidence: 99%

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The Vascularized Fibular Graft in Precollapse Osteonecrosis: Is Long-term Hip Preservation Possible?

Eward

Rineer²,

Urbaniak

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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Results Forty-nine of 65 hips (75%) had surviving FVFG for at least 10 years. At last followup, 39 of 65 hips (60%) had surviving FVFG, with a mean graft survival time of 15 years (range, 10.5-26.1 years). Twenty-six of the 65 hips with FVFG (40%) underwent conversion to THA at a mean of 8 years postoperatively. Demographic factors, lesion size, additional procedures, and low preoperative function were not associated with changes in graft survivorship. Pain and function were similar in patients with surviving FVFG and patients who had conversion to THA. Patients with surviving FVFG were more likely to engage in impact sports or active events than were patients who had conversion to THA. Conclusions When patients with precollapse ONFH undergo FVFG, the majority have preservation of the hip lasting for greater than 10 years with low levels of pain and reasonable function. In patients who ultimately undergo conversion surgery to THA, the mean duration of hip preservation before conversion is 8 years. We continue to use FVFG for treating patients younger than 50 years with symptomatic, precollapse ONFH. Level of Evidence Level IV, therapeutic study. See Instructions to Authors for a complete description of levels of evidence.

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Section: Discussionmentioning

confidence: 99%

“…A technique previously described in detail [1] was used for all procedures. Several technical modifications have been made during the years and were used in our study.…”

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Vascularized Fibular Graft in Precollapse Osteonecrosis: Is Long-term Hip Preservation Possible?

Eward

Rineer²,

Urbaniak

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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“…The FVFG procedure has been described in detail elsewhere [1]. All procedures were performed by one of four surgeons, each of whom performed the procedure in a similar fashion.…”

Section: Methodsmentioning

confidence: 99%

Vascularized Fibular Grafts for Avascular Necrosis After Slipped Capital Femoral Epiphysis: Is Hip Preservation Possible?

Bertrand

Urbaniak

Lark

2013

Clinical Orthopaedics &Amp; Related Research

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Background Avascular necrosis (AVN) of the femoral head is a potential complication in patients with slipped capital femoral epiphysis (SCFE), radiographically occurring in 3-60%. This may lead to early hip fusion or hip arthroplasty. Free vascularized fibular grafting (FVFG) may provide a reasonable means to preserve the femoral head. Questions/Purposes We asked: (1) What percentage of patients with AVN after SCFE treated with FVFG underwent subsequent THA or hip fusion and what was the lifespan of the FVFG? (2) Did the graft survival rate of FVFG for AVN after SCFE coincide with historically reported rates of FVFG for idiopathic AVN? And (3) did hip function improve after FVFG? Methods We retrospectively reviewed 52 patients who underwent FVFG for SCFE. We calculated the longevity of the graft and factors associated with graft survival. Harris hip scores (HHS) were recorded pre-and postoperatively. Minimum followup was 1 month (median, 19 months; range, 1-136 months).

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“…Although a pedicled fibula transfer was first used to fill an ipsilateral tibial defect (without microvascular anastomosis) in 1905 [9], the concept of performing a FVFG was only realised 70 years later [10]. FVFGs were initially used to treat posttraumatic bony defects; however, the indication rapidly broadened to include bony defects resulting from congenital anomalies, infections and tumors [1,2], as well as salvage scenarios including problematic arthrodeses and the treatment of femoral head AVN [11][12][13]. They are currently the mainstay for extreme reconstructions largely because of their particular anatomical characteristics, reliability and versatility.…”

Section: Introductionmentioning

confidence: 99%

Free vascularised fibular grafts in orthopaedics

Bumbaširević

Stevanović

Bumbaširević

et al. 2014

International Orthopaedics (SICOT)

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Bony defects caused by trauma, tumors, infection or congenital anomalies can present a significant surgical challenge. Free vascularised fibular bone grafts (FVFGs) have proven to be extremely effective in managing larger defects (longer than 6 cm) where other conventional grafts have failed. FVFGs also have a role in the treatment of avascular necrosis (AVN) of the femoral head, failed spinal fusions and complex arthrodeses. Due to the fact that they have their own blood supply, FVFGs are effective even in cases where there is poor vascularity at the recipient site, such as in infection and following radiotherapy. This article discusses the versatility of the FVFG and its successful application to a variety of different pathologies. It also covers the applied anatomy, indications, operative techniques, complications and donor-site morbidity. Though technically challenging and demanding, the FVFG is an extremely useful salvage option and can facilitate limb reconstruction in the most complex of cases.

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Free Vascularized Fibular Grafting for the Treatment of Postcollapse Osteonecrosis of the Femoral Head

Cited by 68 publications

References 4 publications

The Vascularized Fibular Graft in Precollapse Osteonecrosis: Is Long-term Hip Preservation Possible?

The Vascularized Fibular Graft in Precollapse Osteonecrosis: Is Long-term Hip Preservation Possible?

Vascularized Fibular Grafts for Avascular Necrosis After Slipped Capital Femoral Epiphysis: Is Hip Preservation Possible?

Free vascularised fibular grafts in orthopaedics

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