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Thursday, February 6, 2003

Free-vascularized fibular grafting can be used after femoral head collapse

Poster P018

Free-vascularized fibular grafting (FVFG) can result in significant functional improvement and reduce pain for young adults with osteonecrosis (ON) of the femoral head, even after femoral head collapse, according to researchers for Poster Exhibit P018.

FVFG is successful for the treatment of early stage ON. Researchers wanted to measure the efficiency of the procedure for the treatment of ON after femoral head collapse and to examine the role of FVFG in the treatment of ON during the time between collapse and arthrosis.

Researchers reviewed 231 consecutive hip cases in 195 patients who had FVFG performed between 1989-1999. All patients had post-collapse/pre-arthrosis ON of the hip. Conversion to total hip arthroplasty (THA) and both pre-operative and most recent follow-up Harris Hip Score (HHS) were recorded. Lesion size, pre-operative femoral head collapse, etiology, age, and bilaterality were examined for significance on conversion to THA.

After a mean follow-up of 4.3 years (range 2 to 12 years), FVFG resulted in a 68 percent overall survival rate of the femoral head. The average preoperative HHS was 56, but this increased to 81 with successful FVFG. Good or excellent results were attained in 63 percent of cases. In those cases where FVFG failed, the mean pre-conversion HHS was 50 and the mean HHS at most recent follow-up after THA was 87.

Researchers found that the etiology of ON was significant for conversion (p=0.02). Increasing lesion size and increasing pre-operative collapse also increased the relative risk of conversion. Age and bilaterality did not affect outcomes (p>0.05).

Based on this study, patients with post-collapse and pre-degenerative ON benefit from FVFG with good overall survival of the femoral head and significant improvements in HHS. The results of this head-preserving procedure are superior to core-decompression and non-operative conservative treatment. Patients with larger lesions, more collapse, and at-risk diagnoses, such as idiopathic and alcohol-related ON, have worse outcomes.

Researchers included Keith R. Berend, MD, of Columbus, Ohio, and Eunice E. Gunneson, PA-C, and James R. Urbaniak, MD, both of Durham, N.C.

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Last modified 20/January/2003