Femoral head osteonecrosis: Why choose free vascularized fibula grafting

Abstract

Osteonecrosis of the femoral head is a disease in which bone death occurs and usually progresses to articular incongruity and subsequent osteoarthritis. To delay the process of the disease and the conversion to total hip arthroplasty, many surgical techniques have been described. Core decompression, nonvascularized autologous bone grafts, porous tantalum implant procedure, and various osteotomies have been used for the management of early precollapse stage osteonecrosis of the femoral head. However, none of these procedures is neither entirely effective nor can obtain predictable results. With the progress of microsurgery, the implantation of a free vascularized fibula graft to the necrotic femoral head has provided the most consistently successful results. Although the procedure is technically demanding, there is growing recognition that the use of free vascularized fibula graft may improve patient quality of life by functional improvement and pain alleviation. The success of the procedure is related to decompression of the femoral head, excision of the necrotic bone, and addition of cancellous bone graft with osteoinductive and osteoconductive properties, which augments revascularization and neoosteogenesis of the femoral head. Free vascularized fibula graft, especially in younger patients, is a salvaging procedure of the necrotic femoral head in early precollapse stages. In postcollapse osteonecrosis, the procedure appears to delay the need for total hip arthroplasty in the majority of patients. The purpose of this review article is to update knowledge about treatment strategies in femoral head osteonecrosis and to compare free vascularized fibula grafting to traditional and new treatment modalities.

Bone regeneration: current concepts and future directions

“…It can also be harvested as a tricortical graft for structural support [16], or as a vascularised bone graft for restoration of large bone defects [17] or avascular necrosis [18]. A variety of sites can be used for bone-graft harvesting, with the anterior and posterior iliac crests of the pelvis being the commonly used donor sites.…”

Tantalum rod implantation for femoral head osteonecrosis: survivorship analysis and determination of prognostic factors for total hip arthroplasty

“…Operative management of ONFH includes joint-salvage procedures such as proximal femoral rotational osteotomy, core decompression sequestrectomy and replacement with bone grafting, non-vascularized cancellous or cortical bone grafting of the lesion, muscle-pedicle bone grafting, free vascularized fibular grafting, and multiple small tantalum pegs [3][4][5][6][7][8][9][10][11][12]. Of these, the most commonly used procedures are core decompression combined with impaction grafting of composite bone material.…”

Dysbaric Osteonecrosis

“…Free vascularized fibular grafts (FVFGs) have also been effective in managing early stages of avascular necrosis of the femoral head. 40,44 This procedure consists of excising a segment of the fibular shaft along with its superficial periosteum and nutrient arteries. The grafts are then transplanted over the necrotic lesions of the long bone with the hope of restoring blood flow.…”