Outcomes of free vascularized fibular graft for post-traumatic osteonecrosis of the femoral head |
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| Institution: | 1. Duke University Hospital, Department of Orthopaedic Surgery, 2310 Erwin Road, Durham, NC 27710, USA;2. Duke University Hospital, Division of Plastic and Reconstructive Surgery, 2310 Erwin Road, Durham, NC, 27710, USA;1. University of Bari “Aldo Moro”. Department of Basic Medical Sciences, Neuroscience and Sense Organs. Orthopaedic and Trauma Unit, Piazza Giulio Cesare, 11. 70124. Bari, Italy;2. Orthopaedic and Trauma Unit, Humanitas Research Hospital, Milano, Italy;1. Department of Orthopaedic Surgery, Faculty of Medicine, University of Thessaly, 3 Panepistimiou St, Biopolis41500Larissa, Greece;2. Department of Orthopaedic Surgery, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece;3. Hand, Upper Extremity and Microsurgery Department, IASO Thessalias, Nikaia41500Larissa, Greece;1. Aristotle University of Thessaloniki, 1st Orthopaedic Department, George Papanikolaou Hospital, Thessaloniki, Greece;2. Aristotle University of Thessaloniki, 1st Orthopaedic Department, George Papanikolaou Hospital, Thessaloniki, Greece;3. Aristotle University of Thessaloniki, Anesthesiology Department, George Papanikolaou Hospital, Thessaloniki, Greece;4. Anesthesiology Department, George Papanikolaou Hospital, Thessaloniki, Greece;5. Aristotle University of Thessaloniki, 1st Orthopaedic Department, George Papanikolaou Hospital, Thessaloniki, Greece;1. Department of Orthopaedic Surgery, Duke University School of Medicine and Health System, Box 104002, Durham, NC 27710, USA;2. Penn Musculoskeletal Center, Penn Medicine University City, 7th Floor, 3737 Market Street, Philadelphia, PA 19104, USA;3. Academic Department of Trauma & Orthopaedics, School of Medicine, University of Leeds, UK;4. NIHR Leeds Biomedical Research Centre, Chapel Allerton Hospital, Leeds, UK;1. Department of Trauma and Orthopaedics, Leeds Teaching Hospitals NHS Trust, UK;2. Academic Department of Trauma and Orthopaedics, University of Leeds, UK |
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| Abstract: | IntroductionOsteonecrosis of the femoral head (ONFH) can occur after traumatic injuries of the hip. Surgical treatment with total hip arthroplasty (THA) may not produce lifelong viability in younger patients. Free vascularized fibular graft (FVFG) has become a reliable method to delay or even avoid THA in this patient population by aiming to correct loss of viable bone through vascularized autologous bone transfer. The purpose of this study was to evaluate the longevity and outcomes of FVFG for traumatic hip injuries resulting in ONFH.MethodsWe performed a retrospective review of our institutional database of patients who had undergone FVFG from 1980-2006 for post-traumatic ONFH and had a minimum follow-up of 5 years. Data collected included demographics, pre-operative Urbaniak ONFH staging, Harris Hip scores (HHS), SF-12 scores, and conversion to THA.ResultsSeventy-two hips in 68 patients met inclusion criteria. Mean follow-up was 11.6 years (range 5.1–33.2 years). Etiology included femoral neck fracture in 36 patients (61%), hip dislocation in 7 (12%), trauma without fracture or dislocation in 11 (19%), and femoral neck nonunion in 5 (8%). The most common stage at presentation was stage IV (48 patients). Graft survival at final follow-up (mean 10.9 years) was 64%, with mean time to conversion to THA of 8.4 years in those that did not survive (36%). There was no difference between THA conversion rates in hips with pre-collapse (Stage I and II) versus impending or post-collapse (Stage III or IV) lesions (p = 0.227). In hips with surviving grafts at final follow-up, mean HHS improved from 56.7 to 77.3 (SD 24.57, range 69–93), a mean improvement of 20.6 (p < 0.001).ConclusionsOur study reveals improvement in HHS in surviving FVFG and an acceptable overall THA conversion rate at mid to long term follow-up in Urbaniak stage I through IV hips. FVFG remains a viable option for treatment in younger patients with pre- and post-collapse (stage IV) ONFH lesions secondary to hip trauma. |
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