BENEFITS AND SURVIVAL OF VASCULARIZED FIBULAR GRAFT IN YOUNG POPULATION WITH AVASCULAR NECROSIS HIP
Keywords:
AVN hip, Aseptic necrosis, Free micro-vascular tissue transfer, Infarction, Ischemic bone necrosis, Pain hip, Osteonecrosis, Vascularized fibulaAbstract
Objective: To highlight the benefits and long term survival of vascularized free fibular graft in the management of avascular necrosis of femoral head and substantiate the fact that it is the best operative treatment modality in younger patients with Ficat Stage III or below.
Study Design: A retrospective study.
Place and Duration of Study: A retrospective study was carried out at the department of burns and plastic surgery, CMH Rawalpindi from Apr 2009 till Apr 2016.
Material and Methods: The study was conducted at department of burns and plastic surgery, CMH Rawalpindi. A total of 42 patients of both sexes with various stages of avascular necrosis of hip mostly Ficat stage II and III disease were operated upon with vascularized free fibular graft over a period of 7 years from Apr 2009 till Apr 2016. The patients were diagnosed on the basis of plain radiography and MRI in all the cases. All the free fibular flaps were performed by the same surgeon, using the same technique in all cases. All patients under went three monthly follow up, serial radiographs, bone scan at three months and post OP MRI at one year. The follow up period ranged from 8 months to 6 years.
Results: All patients had significant pain relief at 4 to 6 weeks post operatively and could walk, sit and stand without support at three months. All flaps survived completely, confirmed by well vascularized femoral head nd neck showing increased activity on bone scan. Repeat MRI scan at 1 year showed halting of disease
progression and some improvement in internal architecture of the femoral head. In none of the case repeat surgery in the form of hip arthroplasty was required.
Conclusion: Vascularized fibular graft can be termed as the gold standard for the management of AVN hip in younger patients with Ficat I to III disease. The biggest benefit being early pain relief, improved quality of life and prevention of need for early hip arthroplasty in these young patients.
