Treatment of osteonecrosis of the femoral head in lymphoma patients by free vascularised fibular grafting

Abstract

The purpose of this study was to assess the outcomes of treatment of femoral head osteonecrosis using free vascularised fibular grafting in patients with Hodgkin's disease and non-Hodgkin's lymphoma. We retrospectively reviewed seven patients (14 hips) with lymphoma who underwent free vascularised fibular grafting for osteonecrosis of the femoral head, evaluating pre-and postoperative Harris hip scores, visual analog scale (VAS) pain scores, hip range of motion and radiographs. Patients were followed up for a minimum of 1.5 years (mean, 3.3 years). All these patients exhibited good recovery without severe lifethreatening complications. The mean Harris hip score improved from 69 to 88, while average VAS pain score decreased from 54 to 18. At the latest follow-up, we found improvement or unchanged radiographs in all three hips with initial Steinberg stage II osteonecrosis and in nine of 11 hips with stage III or IV osteonecrosis. No hips failed treatment and underwent total hip arthroplasty. The clinical data demonstrated that free vascularised fibular grafting can slow or even halt progression of necrosis, and improve the function of the hip and quality of life in lymphoma patients.

Vascularised greater trochanter bone graft, combined free iliac flap and impaction bone grafting for osteonecrosis of the femoral head

“…It has been proved that most hip-preserving surgery can achieve good outcomes only when the necrotic areas are limited to small parts of the femoral head [29]. Current available treatments focusing on reconstruction of the blood supply of femoral head can frequently largely improve the curative effect [30][31][32][33][34]. So does vascularized greater trochanter flap grafting.…”

Chinese Experts' Consensus on the Diagnosis and Treatment of Osteonecrosis of the Femoral Head in Adults

“…The surgical technique of vascularized iliac bone flap combined with tantalum screw has a good short‐term effect. The result of vascularized fibular grafts was confirmed. According to grafts' technical characteristics and surgeons' proficiency choose using graft.…”

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

“…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).…”

“…1,2,4,[8][9][10]15,27,33,52,53 It is widely accepted that the goals of treatment for ONFHN in young people are pain relief, preservation of the femoral head natural contour, improvement of hip joint function, and avoiding conversion to THR. 1,3,[5][6][7]10,13,[16][17][18][19]23,24,27,28,31,34,36,[38][39][40]43 Despite technologic advancements in the last several decades, total hip prosthesis do not have an infinite lifetime. This is particularly relevant since the majority of patients who are diagnosed with ONFHN are younger than the age of 40 years and younger age often correlates with a more active lifestyle and increased wear on prosthetic joints.…”