Treatment of osteonecrosis of the femoral head with free vascularized fibular grafting. A long-term follow-up study of one hundred and three hips.

Urbaniak, James R.; Coogan, Philip G.; Gunneson, Eunice E.; Nunley, James A.

doi:10.2106/00004623-199505000-00004

Cited by 408 publications

(224 citation statements)

References 31 publications

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“…FVFG has reported rates of overall survivorship in the range of 61-96% [2][3][4][15][16][17]. In another study recently performed at our institution looking at 65 hips undergoing FVFG for multiple etiologies contributing to osteonecrosis of the femoral head, 40% of patients went on to THA at an average of 8.3 years after undergoing FVFG [4].…”

Section: Resultsmentioning

confidence: 99%

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Vascularized Fibular Grafts for Avascular Necrosis After Slipped Capital Femoral Epiphysis: Is Hip Preservation Possible?

Bertrand

Urbaniak

Lark

2013

Clinical Orthopaedics &Amp; Related Research

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Background Avascular necrosis (AVN) of the femoral head is a potential complication in patients with slipped capital femoral epiphysis (SCFE), radiographically occurring in 3-60%. This may lead to early hip fusion or hip arthroplasty. Free vascularized fibular grafting (FVFG) may provide a reasonable means to preserve the femoral head. Questions/Purposes We asked: (1) What percentage of patients with AVN after SCFE treated with FVFG underwent subsequent THA or hip fusion and what was the lifespan of the FVFG? (2) Did the graft survival rate of FVFG for AVN after SCFE coincide with historically reported rates of FVFG for idiopathic AVN? And (3) did hip function improve after FVFG? Methods We retrospectively reviewed 52 patients who underwent FVFG for SCFE. We calculated the longevity of the graft and factors associated with graft survival. Harris hip scores (HHS) were recorded pre-and postoperatively. Minimum followup was 1 month (median, 19 months; range, 1-136 months).

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Section: Resultsmentioning

confidence: 99%

“…The free vascularized fibular graft (FVFG) was developed to serve as a biologic support to a devascularized femoral head [16,17]. This procedure uses the patient's autologous fibula with its accompanying vessels, providing a fresh blood supply and bony support to the healing femoral head (Fig.…”

Section: Introductionmentioning

confidence: 99%

Vascularized Fibular Grafts for Avascular Necrosis After Slipped Capital Femoral Epiphysis: Is Hip Preservation Possible?

Bertrand

Urbaniak

Lark

2013

Clinical Orthopaedics &Amp; Related Research

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“…The failure rates of various femoral head-preserving surgical procedures for an extensive ONFH lesion are high [1,10,12,26,32,35,45]. The reported success rate of TRO also is inconsistent and controversial even though some authors including Sugioka et al reported TRO is an effective headpreserving procedure in younger patients [2, 3, 8, 9, 14-16, 21-23, 29, 31, 32, 39-42, 44].…”

Section: Discussionmentioning

confidence: 99%

“…Despite improvements in techniques and materials in total hip arthroplasty (THA), survivorship in young patients is still suboptimal owing to the high rate of complications [7,18,20,33]. Although head-preserving surgeries such as core decompression [10,26] and vascularized and nonvascularized grafting [12,26,32,45] appear to delay the progression of collapse and subsequent arthritic changes, in these studies the indications vary in terms of etiologic factors, radiographic staging, or indications for surgery, and the survival rate of the femoral head decreases with increases in size and stage of the lesion [1,4,10,32].…”

Section: Introductionmentioning

confidence: 99%

Transtrochanteric Rotational Osteotomy for Nontraumatic Osteonecrosis of the Femoral Head in Young Adults

Biswal

Hazra

Yun

et al. 2009

Clin Orthop Relat Res

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Transtrochanteric rotational osteotomy (TRO) is a controversial procedure with reported inconsistent results. We reviewed 50 patients (60 hips) who underwent this procedure for extensive osteonecrosis of the femoral head, focusing on varization to determine its effectiveness as a head-preserving procedure in young adults. The mean age of the patients was 28 years (range, 18-46 years). Using the Ficat-Arlet classification, 40 hips had Stage II and 20 hips had Stage III involvement. According to the classification system of Shimizu et al., the extent of the lesions were Grade C in 54 hips and Grade B in six hips; the location of the lesions were Grade c in 56 hips and Grade b in four hips. Minimum followup was 18 months (mean, 84 months; range, 18-156 months). The mean preoperative Harris hip score was 44.7 points (range, 32-62 points) which improved to an average postoperative score of 80.1 points (range, 44-100 points) at the latest followup. Forty-four hips showed no radiographic evidence of progression of collapse. Ten hips showed progressive collapse, seven hips showed progressive varus deformity, three hips had stress fractures of the femoral neck, and one hip had infection. We believe TRO with varization is worth attempting for extensive osteonecrosis of the femoral head in young adults, although failures and complications are not uncommon.

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“…Once the femoral head has collapsed, hip arthroplasty (HA) is the procedure with the highest likelihood of success [9,14]. Various procedures have been used to preserve the femoral head, including core decompression [4,24], osteotomies [27], and various forms of free vascularized [1, 28,29] or nonvascularized bone grafting (BG) [2,3,15,[19][20][21][22][23]. Most treatment modalities have difficulty in successfully preserving the femoral head.…”

Section: Introductionmentioning

confidence: 99%

One-stage Hip Arthroplasty and Bone Grafting for Bilateral Femoral Head Osteonecrosis

Shih

Wong

Shih

2008

Clin Orthop Relat Res

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Treatment of osteonecrosis of the femoral head with free vascularized fibular grafting. A long-term follow-up study of one hundred and three hips.

Cited by 408 publications

References 31 publications

Vascularized Fibular Grafts for Avascular Necrosis After Slipped Capital Femoral Epiphysis: Is Hip Preservation Possible?

Vascularized Fibular Grafts for Avascular Necrosis After Slipped Capital Femoral Epiphysis: Is Hip Preservation Possible?

Transtrochanteric Rotational Osteotomy for Nontraumatic Osteonecrosis of the Femoral Head in Young Adults

One-stage Hip Arthroplasty and Bone Grafting for Bilateral Femoral Head Osteonecrosis

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