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:10.2106/00004623-200400001-00012

Cited by 58 publications

(51 citation statements)

References 4 publications

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“…Other large, noncomparative studies have reported overall 5-year hip survival rates of 64.5% and 61% for vascularized grafts. 9,10 The success of vascularized grafting using the reversed lateral circumflex artery therefore compares favorably with these series.…”

Section: Discussionmentioning

confidence: 90%

“…The ascending branch of the lateral circumflex femoral artery runs close to the greater trochanter and is commonly used. 8,10 However, it is only of 0.8-1.5 mm in diameter, markedly smaller than the peroneal artery that has a mean diameter of 3.7 mm. 11,12 The descending branch of the lateral circumflex femoral artery may also be used but is a similar size to the ascending branch.…”

mentioning

confidence: 97%

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Reversed flow lateral circumflex femoral vessels as recipients for free fibular grafting in treatment of femoral head osteonecrosis

Lowrie¹,

Rao²,

Nanu³

et al. 2009

Microsurgery

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Free fibular bone grafting is an effective treatment for early osteonecrosis of the femoral head in young patients. However, recipient vessels are often small rendering microvascular anastomosis difficult. We have developed a novel technique using retrograde flow through the branches of the lateral circumflex femoral artery to use the proximal end of the artery as the recipient vessel. A vessel diameter of up to 5 mm is obtained providing a good match with the peroneal vessels. We used this technique to perform vascularized bone grafting of the femoral head in 10 patients with Ficat grade 2 and 3 osteonecrosis. Pulsatile retrograde flow from the lateral circumflex femoral artery was observed in each case. Retrospective review gave a median follow up of 52 months (range 17-99). Symptoms improved in all 10 cases. There was no radiological deterioration over the period of follow-up in eight cases. One patient underwent conversion to a total hip replacement 24 months after surgery. These results compare favorably with other studies. The lateral circumflex femoral artery turnover technique is a reliable and useful technique in vascularized bone grafting of the femoral head.

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Section: Discussionmentioning

confidence: 90%

mentioning

confidence: 97%

Reversed flow lateral circumflex femoral vessels as recipients for free fibular grafting in treatment of femoral head osteonecrosis

Lowrie¹,

Rao²,

Nanu³

et al. 2009

Microsurgery

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show abstract

“…Mechanical support of the femoral head is necessary for weight-bearing and to delay disease progression, especially in patients with early-stage disease (21). This understanding has led to the development of bone transplant with or without blood supply and free fibular transplantation to prevent femoral head collapse (22). However, inconsistent effects and clinical results, shortage of mechanical support and aggressive secondary trauma has limited the achievement of satisfactory results (23).…”

Section: Discussionmentioning

confidence: 99%

Comparison of core decompression and porous tantalum rod implantation with conservative treatment for avascular necrosis of the femoral head: A minimum 18�month follow‑up study

et al. 2020

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Porous tantalum rod implantation is a novel surgical method that is used to treat avascular necrosis (AVN) of the femoral head (hip). In the present study, the results of core decompression and tantalum rod implantation were compared with non-surgical treatment for AVN, and the survivorship of the femoral head was evaluated. In total, 60 patients with AVN femoral head were recruited and analysed. Non-surgical treatment was selected by 30 patients (41 hips), 7 with a Ficat score of I and 23 with a score of II. Non-surgical treatment included celecoxib, salvia miltiorrhiza and tetramethylypyrazine and a reduction in weight-bearing activities. Surgical treatment and porous tantalum rod implantation were selected by 30 patients (41 hips), 10 with a Ficat score of I and 20 with a score of II. After follow-up (average: 33.5 months), patients were evaluated by assessing post-operative complications, radiology, hip survivorship and Harris hip score. In the surgical group, pre-operative symptoms were significantly alleviated. No complications, including infection, delayed healing or fractures were reported. Final follow-up rates of femoral head survivorship were 4.9% in the non-surgical group and 36.7% in the surgical group. The Harris hip score was significantly improved following surgery when compared with non-surgical treatment (P<0.05). The results indicated that core decompression and porous tantalum rod implantation are beneficial short-and mid-term treatment methods for AVN of the femoral head.

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“…[23][24][25][26] In the traditional procedure of FVFG, the fibular graft is inserted into the femoral head through an intraosseous tunnel, extending from the inferior aspect of the greater trochanter to the necrotic area. [5][6][7][8][9][10][11][12][13][14][15][16] The graft and associated peroneal vessels have to be designed with a sufficient length as long as 10 cm. 6 The necrotic tissue is not easy to be thoroughly removed when the femoral neck is not exposed.…”

Section: Discussionmentioning

confidence: 99%

“…2 The free vascularized fibular grafting (FVFG) has been shown as a valuable tool for dealing with ONFH by providing revascularization, mechanical support and vital cells to the femoral head. 3,4 The traditional surgical technique of surgical management of ONFH, [5][6][7][8][9][10][11][12][13][14][15][16] in which the vascular pedicle is dissected prior to osteotomy in the harvest of the vascularized fibular graft and removal of the necrotic tissue of femoral head is performed through the lateral cortex approach, may have some disadvantages including increase of surgery time, difficulties in removal of the necrotic tissue, inset of the vascularized bone graft and microvascular anastomosis, and risk of the proximal femoral fracture.…”

mentioning

confidence: 99%

Modified surgical techniques of free vascularized fibular grafting for treatment of the osteonecrosis of femoral head: Results from a series of 407 cases

et al. 2013

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The goal for treatment of osteonecrosis of the femoral head (ONFH) is to relieve pain, preserve the contour of the femoral head, and delay the need for total hip arthroplasty. The free vascularized fibular grafting (FVFG) has been shown to support the subchondral architecture as well as restore local circulation for the necrotic femoral head in treatment of ONFH. This report aimed to present the clinical results of the use of a modified surgical technique of FVFG for treatment of ONFH. Four hundred and seven patients with 578 hips of ONFH were included. The patients' average age was 36.7 years old (ranging 19-55 years old). The disease was staged from II to V based on the Steinberg classification system. By the modified procedure, the vascularized fibular graft was harvested via a lateral incision with fibular osteotomy prior to the exposure of the vascular pedicle, and the removal of necrotic tissue and inset of graft were performed through an anterior approach. The operative time averaged 90 min for unilateral ONFH (ranging 75-110 min) and 190 min for simultaneous treatment of bilateral ONFH (ranging 160-230 min). The average length of follow-up was 5.0 years (ranging 3-10 years). The complications included one infection in one case, temporary loss of sensation of the thigh in eleven cases, and restricted motion of the great toe in nine cases. The Harris hip score of patients improved from 65.0 to 86.9 on average. Radiographic evaluation showed no changes in 331 hips (57.3%), improvement in 195 hips (33.7%) and necrosis progression in 52 hips (9.0%). Twenty-three hips (4.0%) in 20 patients had total hip arthroplasty during the period. These results show that the modified technique of the use of FVFG for treatment of ONFH yields similar postoperative results in comparison to the traditional method.

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

Cited by 58 publications

References 4 publications

Reversed flow lateral circumflex femoral vessels as recipients for free fibular grafting in treatment of femoral head osteonecrosis

Reversed flow lateral circumflex femoral vessels as recipients for free fibular grafting in treatment of femoral head osteonecrosis

Comparison of core decompression and porous tantalum rod implantation with conservative treatment for avascular necrosis of the femoral head: A minimum 18�month follow‑up study

Modified surgical techniques of free vascularized fibular grafting for treatment of the osteonecrosis of femoral head: Results from a series of 407 cases

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