Free Vascularized Fibular Grafting For The Osteonecrosis Of The Femoral Head - Minimum 5 Years Follow Up

Kee-Haeng Lee, M.D., Youn-Soo Kim, M.D., Dong-Sun Im, M.D., Hyoung-Min Kim, M.D.

Department of Orthopaedic Surgery, Holy Family Hospital, College of Medicine
The Catholic University of Korea, Bucheon, Korea

Purpose: To evaluate the effectiveness of free vascularized fibular grafting (VFG) in the treatment of osteonecrosis of the femoral head.

Materials and Methods: We reviewed the results in a consecutive series of 115 hips (88 patients) who had undergone free VFG between July 1991 and February 1999. Among them, 46 hips (32 patients, 28 males and 4 females) were available with periodic follow up at least 5 years. The mean follow up period was 7.1 years (range, 5 to 13 years). An average age of patients was 37.6 years at the time of VFG. We performed survival analysis by Kaplan-Meier method according to the stage, etiology, age of patients, size of involvement, and degree of collapse of the femoral head. We used the Harris hip score for clinical evaluation, and used plain radiograph and MRI for radiological evaluation.

Results: The survival rates were 85% in Ficat stage 2a, 34.7% in stage 2b, and 76.2% in stage 3. 11 hips were evaluated as failure of VFG in which 7 hips were converted to artificial joint. Harris hip score was 67.8 points preoperatively, and increased to 80.4 points postoperatively. 69.5% of hips showed a good or excellent results clinically and 56.5% radiologically. Age and involvement size of necrosis affected to the postoperative Harris hip score significantly, but other factors did not.

Conclusion: Free VFG for the early osteonecrosis of femoral head revealed satisfactory results with good survival of the joint and much improvement in the Harris hip score.