Free Vascularized Fibular Grafting Preserves Athletic Activity Level in Patients with Osteonecrosis

Sabesan, VJ; Pedrotty, DM; Urbaniak, J. R.; Gahreeb, G; Aldridge, J. Mack

doi:10.5005/jp-journals-10017-1016

Cited by 3 publications

(7 citation statements)

References 14 publications

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“…The surgical management of ONFHN is complex and must be tailored to individual patients. For young patients with early disease (before collapse) and without joint-space narrowing, FVFG has been shown to be a cost-effective option [31] allowing return to high activity levels [32] and remains an appropriate treatment option available to patients. However, for many of these patients, FVFG is not a cure, and they will ultimately have progression of their disease, requiring conversion to THA.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Conversion Total Hip Arthroplasty From Free Vascularized Fibular Grafting

Ryan

Wooster

Jiranek

et al. 2019

The Journal of Arthroplasty

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Keywords:osteonecrosis avascular necrosis free vascularized fibular graft total hip arthroplasty conversion arthroplasty a b s t r a c t Background: Conversion total hip arthroplasties (THAs) from prior free vascularized fibular grafting (FVFG) are infrequently reported in the literature. We characterized the perioperative outcomes of patients undergoing conversion THA and compared them with those of a matched cohort of patients undergoing primary THA for osteonecrosis of the femoral head and neck (ONFHN). Methods: The institutional database was queried for patients with FVFG requiring conversion to THA. This cohort was then matched 1:1 for age, gender, and American Society of Anesthesiologists (ASA) score for patients with ONFHN undergoing primary THA. Medical records were reviewed for intraoperative and postoperative complications, which were then compared between conversion and primary THA patient cohorts. Results: Two hundred eighty-eight THA patients were included for analysis (144 patients with FVFG matched to 144 patients with ONFHN and no prior FVFG). Patients with prior FVFG who underwent THA had significantly greater operative time and blood loss (P < .001). Although not significant, there were more intraoperative fractures in the FVFG cohort (P ¼ .053). Postoperatively, patients with FVFG had significantly greater blood transfusions (P < .001) and hematoma formation (P ¼ .004) than the matched cohort. There was no difference in length of stay, discharge disposition, or venous thromboembolism; however, patients who underwent conversion THA showed increased deep infection (P ¼ .044) and rate of return to the operating room (P ¼ .010). Conclusion: Although there are numerous treatment strategies for patients with ONFHN, many patients will ultimately require THA. Patients undergoing conversion after FVFG are more likely to have complications including increased blood loss, hematoma formation, and intraoperative fractures. Consequently, surgeons should concentrate on preoperative optimization and prepare for specific technical challenges.

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Section: Discussionmentioning

confidence: 99%

Outcomes of Conversion Total Hip Arthroplasty From Free Vascularized Fibular Grafting

Ryan

Wooster

Jiranek

et al. 2019

The Journal of Arthroplasty

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“…B. dem Lunatum (Morbus Kienböck), Skaphoid (Morbus Preiser), Femurkopf und Talus. Als mögliche vaskula risierte Knochengrafts kommen gestielte Späne vom distalen Radius, freie mikrovaskuläre Grafts von der medialen Femurkondyle und freie vaskularisierte Fibulae sowie Beckenkämme in Frage [24][25][26][27][28][29][30]. Chirurgische Angiogenese mittels Knochengraft oder Periosttransplantat kommt auch in der Behandlung von Pseudarthrosen des Skaphoids [26,27], der Klavikula, des Humerus, der Unterarmknochen und der Tibia zur Anwendung [31][32][33][34].…”

Section: Behandlungsoptionen ▼unclassified

Defektrekonstruktion nach onkologischer Resektion und Bestrahlung – Indikationen zur mikrochirurgischen Rekonstruktion

Kremer

Cordts

Hirche

et al. 2015

Handchir Mikrochir plast Chir

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The surgical treatment of soft tissue sarcomas in the extremities frequently requires radiation therapy to achieve local tumour control. However, both adjuvant and neoadjuvant radiation are associated with significant morbidity caused by impaired wound healing, ulcers or osteonecrosis with subsequent fractures. This is due to altered local cell mediator levels, fibrosis occurring simultaneously with decreased cell division rates and diminished vascularity. This article describes a number of local conservative treatment options, all of which have limited success rates. In addition, it describes plastic surgical treatment options for radiation-induced local morbidity. Surgical reconstruction includes the full range of plastic reconstructive techniques. However, less complex options such as random pattern flaps or split thickness skin grafts are often associated with complications. Therefore, a large number of cases require free tissue transfer.

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“…1,9,17,21,23,24,32,34,41,43,[47][48][49][50] Although the pathogenesis is poorly understood overall, there are a variety of direct risk factors that include trauma, radiation, sickle cell disease, caisson disease, and myeloproliferative disorders. 3,4,10,11,23,28,33,43,51 Indirect risk factors include alcohol abuse, chronic corticosteroids, coagulation disorders, statins, human immunodeficiency virus, systemic lupus erythematosus, and pregnancy. 3,4,10,11,23,28,33,43,51 Currently, no single treatment has been identified that undisputedly prevents the progression of the disease.…”

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confidence: 99%

“…3,4,10,11,23,28,33,43,51 Indirect risk factors include alcohol abuse, chronic corticosteroids, coagulation disorders, statins, human immunodeficiency virus, systemic lupus erythematosus, and pregnancy. 3,4,10,11,23,28,33,43,51 Currently, no single treatment has been identified that undisputedly prevents the progression of the disease. This fact only emphasizes the crucial debate regarding the most optimal treatment algorithm for ONFHN especially in the younger population.…”

mentioning

confidence: 99%

“…Despite the absence of a universal treatment protocol, there has been a marked improvement in the knowledge and management of ONFHN in the most recent decades due to the accumulation of further research on the multiple treatment methods. [1][2][3][4]6,[8][9][10][11][12][13][15][16][17][18][19][20][22][23][24][25][26][27][28][29][30][31][33][34][35][36][37][39][40][41][42][43]51 The treatment options for patients are categorized as surgical and nonsurgical interventions. The nonsurgical treatments include restricted weight bearing protocols and pain management, while the surgical options include core decompression (CD) and osteotomy, nonvascularized structural grafts, electrical stimulation, vascularized bone grafts, and THR or total hip arthroplasty (THA).…”

mentioning

confidence: 99%

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The Effectiveness of Free Vascularized Fibular Flaps in Osteonecrosis of the Femoral Head and Neck: A Systematic Review

Ligh

Nelson

Fischer

et al. 2017

J reconstr Microsurg

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Free vascularized fibular flaps (FVFFs) are accepted surgical options to treat osteonecrosis of the femoral head and neck (ONFHN) to prevent conversion to total hip replacement (THR), yet many studies are single institution cohorts, with little generalizability. The purpose of this study was to perform a systematic review examining the comparative effectiveness of FVFF to treat ONFHN, particularly preventing conversion to a THR and improving hip function/symptoms. We searched PubMed and EMBASE databases using femoral head, free fibula, and femoral neck keywords. Articles were excluded if not translated into English, < 10 hips, article was a compilation/review, outcomes were not relevant, or prior to 1994. If from the same institution, we included the largest cohort and excluded others within the same timeline. Two investigators independently reviewed articles and reported number of patients/hips, average age/follow-up time/graft survival before THR, Harris hip score, THR rate, complications, and radiographic progression rates. We identified 128 and 157 articles from PubMed and EMBASE. After screening/duplicate removal, 21 studies were included from 14 institutions in 9 countries. Overall, 71% were level IV evidence. The average patient number was 129, number of hips was 166, age at surgery was 34 years, and follow-up time was 92 months. HHS improved on average 21.7 points, with the number of patients requiring THR being 19.4%. Graft survival before THR was 5.2 years, and 47.7% of hips had radiographic progression. There is a significant amount of level IV evidence describing the favorable role of FVFF to treat ONFHN. Although efficacious, there is a need for higher level evidence. The level of evidence is 3.

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Free Vascularized Fibular Grafting Preserves Athletic Activity Level in Patients with Osteonecrosis

Cited by 3 publications

References 14 publications

Outcomes of Conversion Total Hip Arthroplasty From Free Vascularized Fibular Grafting

Outcomes of Conversion Total Hip Arthroplasty From Free Vascularized Fibular Grafting

Defektrekonstruktion nach onkologischer Resektion und Bestrahlung – Indikationen zur mikrochirurgischen Rekonstruktion

The Effectiveness of Free Vascularized Fibular Flaps in Osteonecrosis of the Femoral Head and Neck: A Systematic Review

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