Treatment of osteonecrosis of the femoral head with free vascularized fibula transfer.

Cho, Yong Kee; Cho, Byung Chae; Lee, Jung Hyung; Baik, Bong Soo; Kim, Shin Yoon

Original Article

Journal of the Korean Society of Plastic and Reconstructive Surgeons 1998;25(5):902-911.
Published online July 1, 1998.

Treatment of osteonecrosis of the femoral head with free vascularized fibula transfer.

Yong Kee Cho, Byung Chae Cho, Jung Hyung Lee, Bong Soo Baik, Shin Yoon Kim

Abstract

Thirty one free vascularized fibula bone grafts were performed for treatment of osteonecrosis of the femoral head in 26 patients, 24 men and 2 women aged from 16 to 48(mean:32 years). Twenty one patients had unilateral disease. Five patients had bilateral disease underwent staged bilateral free vascularized fibula grafts three months apart. Associated etiological factors included alcohol(9 patients), steroid(7 patients), and trauma(one patient). The condition was considered idiopathic in the remaining 9 patients. Radiologic staging by Ficat included stage 1 in one hip, stage II in 15 hips, stage III in 14 hips, and stage IV in one hip. A skin island flap was used for monitoring purpose for the grafted fibula. One monitoring, flap was necrotized due to vascular occlusion but the fibula bone graft was left in place to use as a nonvascularized bone graft. Average follow-up period was 21 months in 31 hips. Pain was relieved in 28 hips(93.3 percent) and aggravated in 2 hips(6.7 per cent). On radiographic evaluation, 26 hips(86.7 per cent) demonstrated excellent preservation of the femoral head contour. Progressive collapse of the femoral head (greater than 1-2 mm) occurred in 2 hips, i mm depression in one hip with stage III and 2 mm collapse in one hip with stage IV. In conclusion, the free vascularized fibula bone graft is an excellent treatment modality for preserving the femoral head and relieving symptoms in cases of the osteonecrosis of the femoral head.