Long-Term Results in the Treatment of Avascular Necrosis of Femoral Head with Free Vascularized Fibular Graft
DOI:
https://doi.org/10.51253/pafmj.v73i6.7678Keywords:
Avascular femoral head necrosis, Harris hip scores and vascularized fibular graftAbstract
Objective: to evaluate outcomes of vascularized fibula flap used for Avascular necrosis of femoral head. Outcomes were
recorded by post-operative Harris hip and radiological improvement of the femoral head.
Study Design: Retrospective longitudinal study.
Place and Duration of Study: Department of Plastic Surgery, Shifa International Hospital, Islamabad Pakistan, from Jan 2019 to Jan 2020.
Methodology: Cases were recruited from 2005-2018 (SIH) performed by the same Orthopaedic and Plastic Surgeon. Data from 30 patients was reviewed. Ethical approval and consent of the patient were taken before the utilization of their data.
Results: A total of 30 patients were included, comprising 27(90%) males and 3(10%) females. The mean age was 28.3± years. Pre-operative Harris Hip scores were fair in 17(56.7%) and poor in 13(43.3%) patients. Post operatively these scores improvedv and were noted to be excellent in 10(33.3%), good in 18(60%) and fair in 2(6,7%) patients. Radiological improvement was seen in 20(80%) patients, 8(23.3%) showed no change and 2(6.7%) went into progression. The radiological improvement was significantly associated with aetiology (p=0.004) and Avascular necrosis of HIP (p=0.007).
Conclusion: A vascularized fibular graft is an effective treatment option for avascular necrosis of the femoral head in terms of improved radiological outcomes and post-operative Harris Hip scores.
Downloads
References
Urbaniak JR, Coogan PG, Gunneson EB, Nunley JA. Treatment ofosteonecrosis of the femoral head with FVFG. A long-term followup study of one hundred and three hips. J Bone Joint Surg Am2018; 77(3): 681–694.https://doi.org/10.2106/00004623-199505000-00004.
Moya-Angeler J, Gianakos AL, Villa JC, Ni A, Lane JM. Currentconcepts on osteonecrosis of the femoral head. World J Orthop2016; 6(8): 590–601.https://doi.org/10.5312%2Fwjo.v6.i8.590.
Zhang Y, Li L, Shi ZJ, Wang J, Li ZH. Porous tantalum rodimplant is an effective and safe choice for early-stage femoral headnecrosis: a meta-analysis of clinical trials. Eur J Orthop SurgTraumatol 2017; 23(2): 211–217.
https://doi.org/10.1007/s00590-012-0962-7.
Berend KJ, Roper JG, Wang JC. Demineralized bone matrix andspinal arthrodesis. Spine J 2018; 5(6): 217–223.
https://doi.org/10.1016/j.spinee.2005.02.006.
Kim SB, Kock NB, Dijkstra PD, Taminiau AH, Nelissen RG.Treatment of avascular necrosis of the hip by a non-vascularised
cortical graft. J Bone Joint Surg Br 2019; 88(4): 460–466.https://doi.org/10.1302/0301-620x.88b4.16950.
Ali AS, Christy MJ, Griesser JM, Awan H, Pan X, Ellis JT, et al.Treatment of avascular necrosis of the femoral head utilising freevascularised fibular graft: a systematic review. Hip Int 2014; 24(1):5-13. https://doi.org/10.5301/hipint.5000076.
Zhao DW, Yu M, Hu K, Wang W, Yang L, Wang BJ, et al.Prevalence of Nontraumatic Osteonecrosis of the Femoral Head
and its Associated Risk Factors in the Chinese Population: Resultsfrom a Nationally Representative Survey. Chin Med J (Engl) 2015;128(21): 2843-2850. https://doi.org/10.4103/0366-6999.168017
Vardhan H, Tripathy SK, Sen RK, Aggarwal S, Goyal T.Epidemiological Profile of Femoral Head Osteonecrosis in the
North Indian Population. Indian J Orthop 2018; 52(2): 140-146.https://doi.org/10.4103%2Fortho.IJOrtho_292_16.
Zalavras CG, Lieberman JR. Osteonecrosis of the femoral head:evaluation and treatment. J Am Acad Orthop Surg 2016; 22(7):455–464. https://doi.org/10.5435/jaaos-22-07-455.
Nally FJ, Zanotti G, Buttaro MA, Dilernia FD, Mansilla IG, CombaFM, et al. THAconversion rate comparing decompression alone,with autologous bone graftor stem cells in osteonecrosis. Hip Int2018; 28(2): 189-189.https://doi.org/10.5301/hipint.5000552.
Wei BF, Ge XH. Treatment of osteonecrosis of the femoral headwith core decompression and bone grafting. Hip Int 2011; 21(2):206-210. https://doi.org/10.5301/hip.2011.6525.
Yoo MC, Kim KI, Hahn CS, Parvizi J. Long-term follow-up ofvascularized fibular grafting for femoral head necrosis. Clin
Orthop Relat Res 2018; 466(5): 1133–1140.https://doi.org/10.1007%2Fs11999-008-0204-9.
Kawate K, Yajima H, Sugimoto K. Indications for FVFG for thetreatment of osteonecrosis of the femoral head. BMC
Musculoskelet Disord 2017; 8(3): 78-79.http://doi.org/10.1186/1471-2474-8-78.
Berend KR, Gunneson EE, Urbaniak JR. FVFG for the treatment ofpostcollapse osteonecrosis of the femoral head. J Bone Joint SurgAm 2017; 8(6):987–993.
Weinstein RS, Nicholas RW, Manolagas SC. Apoptosis ofosteocytes in glucocorticoid-induced osteonecrosis of the hip. J
Clin Endocrinol Metab 2000; 85(1): 2907-2912.http://doi.org/10.1210/jc.85.8.2907.
Ünal BM, CansuE, Parmaksızoğlu F, Cift H, Gürcan S. Treatmentof osteonecrosis of the femoral head with free vascularized fibulargrafting: Results of 7.6-year follow-up. Acta Orthop TraumatolTurc 2016; 50(5): 501–506.
https://doi.org/10.1016%2Fj.aott.2016.01.001.
Sotereanos DG, Plakseychuk AY, Rubash HE. Free vascularizedfibula grafting for the treatment of osteonecrosis of the femoralhead. Clin Orthop 2017; 34(4):243–256.
Jaffré C, Rochefort GY. Alcohol-induced osteonecrosis--dose andduration effects. Int J Exp Pathol 2012; 93(1): 78-79.
https://doi.org/10.1111/j.1365-2613.2011.00798_1.x.
Meyers MH. The surgical treatment of osteonecrosis of thefemoral head withan osteochondral allograft. Acta Orthop Belg1999; 65(Suppl 1): 66e7.
Downloads
Published
Issue
Section
How to Cite
