Background: The present study evaluates the minimum five-year
results of vascularized fibular grafting for the treatment of osteonecrosis of
the femoral head. The purposes of the present study were to review the results
of fibular grafting in a large series of patients and to determine the
indications for this procedure.
Methods: Eighty-six patients (101 hips) were followed clinically for
a minimum of five years (or until the time of death). The study group included
fourteen Marcus-Enneking stage-2 hips, twenty-three stage-3 hips, and
sixty-four stage-4 hips. Three patients (three hips) died from unrelated
causes before the five-year evaluation, and two patients (two hips) died after
the five-year evaluation. Radiographic assessment was performed with use of
the Marcus-Enneking grading system, and clinical assessment was performed with
use of the Harris hip-scoring system. The end point was conversion to total
hip arthroplasty. Patient satisfaction was also assessed.
Results: Sixty-two hips (61%) survived until the time of the
five-year follow-up, and forty-two hips (42%) survived until the time of the
interview (at a median of eight years postoperatively). The average Harris hip
score was 58 ± 13 at the time of presentation and 80 ± 15 at
five years. Eight (57%) of the Marcus-Enneking stage-2 hips, sixteen (70%) of
the stage-3 hips, and thirty-eight (59%) of the stage-4 hips survived for at
least five years. Of the eighty-one living patients (including forty-one who
had a successful outcome and forty who had had a failure), forty-six patients
(including twenty-one who had a successful outcome and twenty-five who had had
a failure) stated that they would undergo the procedure again.
Conclusions: Vascularized fibular grafting may provide a chance for
normal hip function in the intermediate or long term in carefully selected
patients with osteonecrosis of the femoral head.
Level of Evidence: Therapeutic Level IV. See Instructions
to Authors for a complete description of levels of evidence.