Acta Orthopaedica et Traumatologica Turcica
Research Article

Clinical results of free vascularized fibula graft in the management of precollapse osteonecrosis of the femoral head: A retrospective clinical study

1.

University of Health Sciences, Baltalimanı Bone Diseases Training and Research Center, İstanbul, Turkey

2.

Department of Orthopedics, VM Medical Park Maltepe Hospital, İstanbul, Turkey

3.

Department of Orthopedics, University of Health Sciences, Ümraniye Health Research Center, İstanbul, Turkey

AOTT 2022; 56: 105-110
DOI: 10.5152/j.aott.2022.21012
Read: 164 Downloads: 106 Published: 01 March 2022

Objective: This study aimed to evaluate clinical results, femoral head survival, and the need for total hip arthroplasty (THA) in patients with precollapse osteonecrosis of the femoral head (OFH) (Steinberg stage II and III) treated by free vascularized fibula graft (FVFG) application.

Methods: We retrospectively reviewed 54 hips of 47 patients (39 males, eight females; mean age 36 ± 14 years) who underwent FVFG due to OFH, with at least two years of follow-up. The patient data, including Harris Hip Score (HHS), Visual Analogue Scale (VAS), and conversion to THA, were documented.

Results: The right hip of 26 patients and the left hip of 28 patients were involved. Bilateral FVFG surgery was performed on seven patients due to bilateral OFH. The mean follow-up time was 5.5 (range 2-14) years. Survival of the femoral head was observed in 39 hips (72.2%), while the femoral head collapse was observed in 15 femoral heads (27.8%). The mean preoperative HHS increased from 46.5 (range=12-85) to 86.5 (range=33-100) postoperatively (P < 0.001). The mean preoperative VAS score improved from 8.2 (range=2-10) to 1.3 (range=0-10) postoperatively (P < 0.001). THA was performed on seven hips at a mean follow-up time of 1.8 years (range=0.7–3.3). There was no significant difference in the collapse rate between unilateral or bilateral OFH (P=0.175). A higher survival rate was observed in the Steinberg stage II femoral head patients compared to the stage III femoral head (P=0.021).

Conclusion: This study has shown that FVFG surgery can be a good option for managing patients with Steinberg stage II and III precollapse OFH to prevent femoral head collapse and joint function.

Level of Evidence: Level IV, Therapeutic Study

Cite this article as: Öztürk K, Baydar M, Alpay Y, Şencan A, Orman O, Aykut S. Clinical results of free vascularized fibula graft in the management of precollapse osteonecrosis of the femoral head: A retrospective clinical study. Acta Orthop Traumatol Turc. 2022;56(2):105-110.

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ISSN 1017-995X EISSN 2589-1294