Long-term survival and clinical outcomes of non-vascularized autologous and allogeneic fibular grafts are comparable for treating osteonecrosis of the femoral head

Abstract

Background Osteonecrosis of the femoral head (ONFH) is a disabling disease, which often involves young patients. Recently, various hip-preserving surgeries were recommended to delay total hip arthroplasty (THA). Questions/purposes This study aimed to compare clinical outcomes and survival rate in the long-term follow-up between core decompression combined with a non-vascularized autologous fibular graft (group A) and an allogeneic fibular graft (group B) for the treatment of ONFH. Patients and methods We retrospectively evaluated 117 patients (153 hips) with ONFH (Association Research Circulation Osseous [ARCO] stages IIa to IIIc) who underwent the abovementioned hip-preserving surgeries between January 2003 and June 2012. The mean (range) follow-up times (years) were 12.9 (7–16) and 9.3 (6–16) in groups A and B, respectively. Clinical outcomes were assessed using the Harris Hip Score (HHS), visual analog scale (VAS) score, and forgotten joint score (FJS). A survival analysis was performed using the Kaplan-Meier method. The end point was THA. Results Groups A and B showed postoperative improvements, respectively, in HHS from 65 ± 7.2 to 80.3 ± 14.5 and from 66 ± 5.9 to 82.4 ± 13.6 (p < 0.05), and in VAS score from 6.3 ± 1.1 to 2.3 ± 1.6 and from 6.1 ± 1 to 2.2 ± 2.2 (p < 0.05). However, no significant differences in the HHS, VAS score, and hip FJS at the last follow-up (p > 0.05) and 15-year survival rate (84.1% and 86%, respectively, p > 0.05) were found between groups A and B. Conclusions Autologous and allogeneic fibular grafts can attain equally good clinical outcomes and high survival rates in long-term follow-up, and thus can greatly delay THA owing to good bone osseointegration and sufficient mechanical support. Notably, the ratio of failure will increase when patients were more than 37 years old. Level of evidence Level III, therapeutic study

One in five patients require conversion to arthroplasty after non-vascularized bone grafts in patients with osteonecrosis of the femoral head: a systematic review

“…One study compared clinical outcomes and survival rate in the long-term follow-up between non-vascularized autologous fibular graft and an allogeneic fibular graft for the treatment of ONFH [ 21 ]. There is no appreciable difference in the rate of conversion to THA between autologous fibular graft group (12%) and allogeneic fibular graft group.…”

Preliminary report of the outcomes and indications of single approach, double-channel core decompression with structural bone support and bone grafting for osteonecrosis of the femoral head

“…Free vascularized fibular grafts for post-traumatic ONFH reportedly resulted in a survival rate of 64% and average HHS of 77.3±24.57 points after a mean follow-up of 10.9 years [ 17 ]. A long-term comparative study of non-vascularized autologous versus allogeneic fibular grafts for ONFH found no significant differences in the HHS (80.3±14.5 and 82.4±13.6 respectively) and survival rate (84.1 and 86% respectively) [ 18 ]. After a mean follow-up of 42 months, the survival rate of a porous tantalum implant combined with bone grafting to treat ONFH was only 52.9%, which shows that this is not a viable option for treating ONFH [ 19 ].…”

Comparison of minimally-invasive fibular supporting of T-type with traditional bloody iliac flap metastasis for osteonecrosis of the femoral head at ARCO stage II

“…After sufficiently decompressing the necrotic area of the femoral head using the Advanced Core Decompression introduced in the literature [ 28 ], we used the T-shaped support method in the tunnel theory for reference to provide strong support. A long-term comparative study of allogeneic fibular grafts versus non-vascularized autologous for ONFH found no significant differences in the HHS (82.4 ± 13.6 and 80.3 ± 14.5 respectively) and survival rate (86% and 84.1% respectively) [ 29 ]. Our findings were in agreement with that results.…”