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

Abstract

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.

Descending branch of the lateral circumflex femoral artery as a recipient vessel for vascularized fibular grafts: Clinical case series

“…In their technique, they performed fibular osteotomy before exposing vascular pedicle. They reported 578 hips using this technique with a mean operative time of 90 min (range 75–110) …”

Biomechanical Analysis of Fibular Graft Techniques for Nontraumatic Osteonecrosis of Femoral Head: A Finite Element Analysis

“…If so, hip replacement becomes unavoidable, which is reluctant for young patients due to revision surgery and nancial burden 4,5 . Among the preservation procedures, free vascularized bula graft (FVFG) has achieved the most consistent successful therapeutic effect on the treatment of early NONFH, which includes the removal of necrotic lesion under weight-bearing area, buttressing articular surface by grafted bula and revascularization of femoral head 2,6−10 . Current procedures of FVFG mainly include Core Tack technique (CTT) 11 and modi ed Light Bulb technique (LBT) 10 , with success rates of 60%-90% and 94.6%-96%, respectively 2,10−13 . CTT is the most commonly used technique for treating NONFH, which is ful lled by drilling a core tunnel from the lateral aspect of the greater trochanter, removing necrotic bone tissue and implanting bone.…”

“…However, this technique reams more healthy bone, harvests longer bula graft, demands a longer bular pedicle and a longer operation duration. As an alternative to CTT, LBT is applied, which initially described by Rosenwasser 14 and subsequently modi ed by Zhang and his colleagues as one of the FVFG techniques 10 . To implement the modi ed LBT, a window is opened in the anterolateral cortex of the femoral neck.…”

Complications related to harvest of the proximal end of the fibula: A systematic review

“…Free vascularized fibula grafts are commonly used for the reconstruction of bony defects in the head and neck, extremities, spine, and pelvis and avascular necrosis of femoral head . Most commonly, the mid‐portion of the fibula is harvested, with preservation of the proximal and distal articulations.…”