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

Abstract

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).

Modified trapdoor procedures using autogenous tricortical iliac graft without preserving the broken cartilage to treat osteonecrosis of the femoral head: A Prospective Cohort Study With Historical Controls

“…Broken cartilage and necrotic subchondral bone was no longer replanted. Compared with previous studies [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] , this report includes superior results. The rate of clinical success (good or excellent outcome) was 92.5% for 67 hips.…”

“…The rationale for head-preserving procedures is the desire to provide sufficient and long-lasting support to necrotic subchondral bone and cartilage [38] , in order to prevent collapse and subsequent osteoarthrosis of the joint. A tantalum rod was used to provide direct mechanical support [16] ; a bone graft was aimed to replace dead bone with viable bone [12][13][14] . Various types of stem cells and/or biofactors were used to facilitate bone formation and remodeling, alone or in combination with other methods [15,19] .…”

“…The treatment procedures performed most commonly include core decompression, osteotomy, non-vascularized or vascularized bone graft, enriched bone substitutes, transplantation of a tantalum rod, and autologous bone marrow stem cell implantation. All of these procedures aim to promote bone regeneration and/or provide mechanical support [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] . However, none of these treatment modalities have been found to be universally successful.…”

Outcomes of Conversion Total Hip Arthroplasty From Free Vascularized Fibular Grafting

“…Regardless of the treatment, patients remain at a risk of further progression of disease and may ultimately require THA. At the investigating institution, FVFG is a common treatment strategy used for patients with early stages of ONFHN as it has shown to provide significant improvement in patient pain and activity levels, delaying the need for THA [1,5,13,20,21]. Still, the rate of conversion to THA has been reported at 19.4% at 5.2 years in a recent meta-analysis [1].…”

Free vascularised fibular grafts in orthopaedics

“…Only 8 % of patients needed joint replacement in one study [48], and surgery was postponed by up to seven years in 70 % of patients in another report [9]. FVFGs have also been successful in treating teenagers with posttraumatic AVN [48,49], improving Harris hip scores (HHS) from 60.4 to 94.2, and appear to give more successful outcomes than other joint-preserving procedures [48][49][50]. Ultimately, the success of FVFGs depends on AVN aetiology, stage and size [13].…”