Indications for free vascularized fibular grafting for the treatment of osteonecrosis of the femoral head

Kawate, Kenji; Yajima, Hiroshi; Sugimoto, Kazuya; Ono, Hiroshi; Ohmura, Tetsuji; Kobata, Yasunori; Murata, Keiichi; Shigematsu, Koji; Kawamura, Kenji; Kawahara, Ichiro; Maegawa, Naoki; Tamai, Katsuya; Takakura, Yoshinori; Tamai, Susumu

doi:10.1186/1471-2474-8-78

Cited by 51 publications

(59 citation statements)

References 36 publications

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“…It has been proved that most hip-preserving surgery can achieve good outcomes only when the necrotic areas are limited to small parts of the femoral head [29]. Current available treatments focusing on reconstruction of the blood supply of femoral head can frequently largely improve the curative effect [30][31][32][33][34]. So does vascularized greater trochanter flap grafting.…”

Section: Discussionmentioning

confidence: 99%

Vascularised greater trochanter bone graft, combined free iliac flap and impaction bone grafting for osteonecrosis of the femoral head

Zeng

He²,

Feng³

et al. 2013

International Orthopaedics (SICOT)

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Purpose To investigate the curative efficacy of osteonecrosis of the femoral head (ONFH) in a hip-preserving operative approach, by grafting a vascularized greater trochanter flap combined with a free iliac flap, in an attempt to seek an innovative approach for patients who suffered middle to late stage ONFH without total hip arthroplasty (THA) surgery. Method Our research included a total of 60 patients (66 hips) who accepted hip-preserving surgery by grafting a vascularized greater trochanter flap combined with a free iliac flap which was tightly filled by hammering because of ONFH (most were Association Research Circulation Osseous (ARCO) stage III patients) from January, 2006 to December, 2010. A Harris Hip Score was obtained during follow-ups, evaluating the clinical efficacy, X-rays were taken regularly for image assessing, and the SF-36 scale was used for estimating quality of life. Terminal observation time was considered when patients had symptom-dependant indications for performing another hip-preserving surgery or THA surgery. Results Fifty-eight patients (64 hips) were eventually contacted by telephone for an out-patient clinic return visit, with a mean follow-up time of 35.8 months (varied from 12 months to 60 months), but two patients lost contact for various reasons. The demographic data were as follows: there were 16 ARCO IIIA cases, 22 ARCO IIIB cases, and 26 ARCO IIIC cases, respectively. Postoperative X-rays revealed a well-repaired necrotic area of the femoral head and improvement of femoral-acetabulum coverage. The last follow-up mean Harris Hip Score was 86.56±7.38 (excellent results reached 87.50 %), which were greatly improved compared to 50.95±6.86 pre-operatively. Also the postoperative mean scores of all dimensions of the SF-36 scale were improved to some extent. Additionally the physical component summary (PSC) scores were enhanced from 42± 13 pre-operatively to 78±11, while the postoperative mental component summary (MCS) scores (76±11) largely increased in contrast to pre-operative scores (51±10), with both target indices having statistical significance (p=0.005, p=0.01), signifying hugely improvement of the quality of life of the patients. A correlation was found between Harris Hip Score and all dimensions of SF-36 scale (r=0.32-0.72), especially closely correlated with physical functioning (PF), role-physical (RP) and bodily pain (BP) in PCS aspect (r= 0.72, p < 0.01; r = 0.58, p < 0.01; r = 0.65, p < 0.01, respectively). Conclusion There is definite curative efficacy for the treatment of ONFH with an hip-preserving operative approach by grafting a vascularized greater trochanter flap combined with a free iliac flap which was tightly filled by hammering. This kind of operative approach reconstructs the biological stability of femoral head, which promotes repair of necrotic areas and indirectly preserves the femoral head of patients and a majority of hip function. It possesses vast clinical as well as practical significance, because the long-term efficacy can satisfy fundam...

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Section: Discussionmentioning

confidence: 99%

Vascularised greater trochanter bone graft, combined free iliac flap and impaction bone grafting for osteonecrosis of the femoral head

Zeng

He²,

Feng³

et al. 2013

International Orthopaedics (SICOT)

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“…Their clinical success rate, reported for 188 cases (224 hips) with an average follow-up of 4.3 years, was 67.4% after 2 years, 64.5% after 5 years, and 63%, overall. Kawate et al, (2007) reported a 7-year success rate of 67%, and indicated that the success rate in patients with preoperative, pre-collapsed ONFH was significantly higher than that in patients with preoperative, collapsed ONFH. However, vascularized bone graft surgery is a long, complex surgery that is more traumatic and subject to significant complications, such as peroneal nerve palsy, post-transplantation subtrochanteric fracture, and ankle pain.…”

Section: Discussionmentioning

confidence: 99%

Porous tantalum rods for treating osteonecrosis of the femoral head

Liu¹,

Guo²,

Li³

et al. 2014

Genet. Mol. Res.

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ABSTRACT. This study evaluated the outcomes of using porous tantalum rods for the treatment of osteonecrosis of the femoral head (ONFH). We performed core decompression and inserted porous tantalum implants in 149 patients (168 consecutive hips) with ONFH. Hips had large (65), medium (64), or small (39) lesions; 63 lesions were lateral, 68 were central, and 35 were medial. Conversion to total hip arthroplasty (THA) was the end point of this survey. A total of 130 cases (138 hips) were followed. The mean follow-up time was 38.46 ± 5.76 months; 43 hips (31%) were converted to or needed THA. Of the 43 hips requiring THA, 33 had large lesions, including 1 medial, 3 central, and 29 lateral lesions; 9 had medium, lateral lesions, and 1 hip had a small, lateral lesion. Bone grafting was used in 59 hips, with 3 hips failing; 40 of 79 hips without bone grafts failed. The sum distances between the tops of the rods and the lateral lesion boundaries (SDTL, mm) were measured in anteroposterior and lateral radiographs. In the failure and spared groups, the average SDTLs were 7.65 ± 2.759 and 0.83 ± 2.286 mm, respectively. The survival of porous tantalum rods used for treating early-stage ONFH was affected by the size and location of the lesion, whether or not a 8343 ©FUNPEC-RP www.funpecrp.com.br Genetics and Molecular Research 13 (4): 8342-8352 (2014) Porous tantalum rods for treating osteonecrosis bone graft was used, as well as the distance between top of the rod and the lateral boundary of the lesion.

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“…The safety of the procedure was determined by the incidence of postoperative major and minor complications [4,14].…”

Section: Resultsmentioning

confidence: 99%

“…FVFG is an attractive alternative to all the aforementioned options, especially for younger patients without severe osteoarthritis of hip joint [14]. The advantage of FVFG lies in the combination of femoral head decompression, removal of necrotic lesion, introduction of osteoinductive cancellous bone, and vascularised cortical bone support of the subchondral surface [24].…”

Section: Discussionmentioning

confidence: 99%

Treatment of osteonecrosis of the femoral head in lymphoma patients by free vascularised fibular grafting

Yin

Zhang

Jin

et al. 2010

International Orthopaedics (SICOT)

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The purpose of this study was to assess the outcomes of treatment of femoral head osteonecrosis using free vascularised fibular grafting in patients with Hodgkin's disease and non-Hodgkin's lymphoma. We retrospectively reviewed seven patients (14 hips) with lymphoma who underwent free vascularised fibular grafting for osteonecrosis of the femoral head, evaluating pre-and postoperative Harris hip scores, visual analog scale (VAS) pain scores, hip range of motion and radiographs. Patients were followed up for a minimum of 1.5 years (mean, 3.3 years). All these patients exhibited good recovery without severe lifethreatening complications. The mean Harris hip score improved from 69 to 88, while average VAS pain score decreased from 54 to 18. At the latest follow-up, we found improvement or unchanged radiographs in all three hips with initial Steinberg stage II osteonecrosis and in nine of 11 hips with stage III or IV osteonecrosis. No hips failed treatment and underwent total hip arthroplasty. The clinical data demonstrated that free vascularised fibular grafting can slow or even halt progression of necrosis, and improve the function of the hip and quality of life in lymphoma patients.

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Indications for free vascularized fibular grafting for the treatment of osteonecrosis of the femoral head

Abstract: Background: The present study aimed to determine the indications for free vascularized fibular grafting for the treatment of osteonecrosis of the femoral head.

Cited by 51 publications

References 36 publications

Vascularised greater trochanter bone graft, combined free iliac flap and impaction bone grafting for osteonecrosis of the femoral head

Vascularised greater trochanter bone graft, combined free iliac flap and impaction bone grafting for osteonecrosis of the femoral head

Porous tantalum rods for treating osteonecrosis of the femoral head

Treatment of osteonecrosis of the femoral head in lymphoma patients by free vascularised fibular grafting

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