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Free Vascularized Fibular Transfer for Femoral Head Osteonecrosis: Donor and Graft Site Morbidity
Trevor R. Gaskill, MD1; James R. Urbaniak, MD2; J. Mack AldridgeIII, MD2
1 Division of Orthopaedic Surgery, Duke University Medical Center, Box 3000, Durham, NC 27710. E-mail address: gaski011@mc.duke.edu
2 Division of Orthopaedic Surgery, Duke University Medical Center, Box 3293, 3116 North Duke Street, Durham, NC 27705
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Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a comnmercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.
Investigation performed at the Division of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina

The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2009 Aug 01;91(8):1861-1867. doi: 10.2106/JBJS.H.01105
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Background: Autogenous vascularized fibular transfer is used effectively for a variety of complex reconstructive procedures. Published series demonstrating the morbidity associated with its harvest have, understandably, been relatively small, and graft site (hip) complications have not been reported. This report describes both the donor and the graft site morbidity associated with use of vascularized fibular transfer to treat osteonecrosis of the femoral head.

Methods: Between 1990 and 2006, 1270 free vascularized fibular grafts were used to treat osteonecrosis of the femoral head in 946 consecutive patients. All procedures and follow-up examinations were performed by one of two surgeons. Subjective and objective findings were recorded on standardized examination sheets at routine postoperative intervals. Data were analyzed to determine the morbidity associated with donor and graft sites.

Results: There were 215 complications (a 16.9% rate) at the time of follow-up, at an average of 8.3 years, after the 1270 procedures. Of these complications, 146 (11.5%) and sixty-nine (5.4%) were referable to the donor and graft sites, respectively. A major complication requiring an additional surgical procedure or chronic pain management occurred after fifty-four (4.3%) of the 1270 procedures.

Conclusions: A measurable but acceptable morbidity risk is associated with vascularized fibular transfer for the treatment of osteonecrosis of the hip. Major complications are not frequent, and many minor complications are transient and improve over time. Risks can be minimized when specific technical principles are followed.

Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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