Treatment of femoral head necrosis with free vascularized fibula grafting: A preliminary report

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Treatment of skeletal defects secondary to osteomyelitis is a challenging problem. The purpose of this study was to present our experience of the use of free vascularised fibular grafts to treat such defects. Ten patients with a mean age of 31 years (range 16-50 years) and a skeletal defect with a mean length of 9.5 cm (range 6-17 cm) were managed with a protocol which included radical debridement of the lesion and a vascularised fibular graft. The mean follow-up time was 26 months. Union of the graft occurred in all patients, at a mean of 4.5 months. No recurrence of osteomyelitis was observed. The mean time to full weight bearing was ten months, and all patients were pain-free and able to walk without supportive devices. A free vascularised fibular graft is a viable option for the management of large skeletal defects resulting from osteomyelitis.

Section: Management Protocolmentioning

confidence: 99%

Free vascularised fibular grafting in the treatment of large skeletal defects due to osteomyelitis

Sun

Zhang

Jin

et al. 2009

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“…Indications for the surgery included stage II, III, IV and occasionally stage V osteonecrosis and pain at the time of evaluation. According to the Steinberg classification, three hips were in stage II (22%), nine hips were in stage III (64%), two hips were in stage IV (14%) and no hips were in stage V. The operative technique performed in these patients has been previously described by the senior author [8]. Of those with bilateral osteonecrosis, only one patient underwent unilateral FVFG twice in 13 months, whereas the others underwent direct bilateral procedures.…”

Section: Methodsmentioning

confidence: 92%

“…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]. There are multiple reports on the successful mid-and long-term outcomes of FVFG [7][8][9]. Zhang et al [8] used FVFG to treat 56 hips in 48 patients, with mean follow-up of 16 months.…”

Section: Discussionmentioning

confidence: 99%

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

Yin

Zhang

Jin

et al. 2010

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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.

“…After an average of 16 months follow-up, 39 hips (69.6 %) showed improvement [34]. The advantage of this surgical method is that the graft can support the femoral head and prevent its further collapse.…”

Section: Discussionmentioning

confidence: 99%

Umbrella-shaped, memory alloy femoral head support device for treatment of avascular osteonecrosis of the femoral head

Wen-xiong

Pan

et al. 2013

Purpose Avascular necrosis (AVN) of the femoral head is a common orthopaedic disease that is difficult to treat. The purpose of this study was to explore the preliminary efficacy of a self-designed umbrella-shaped memory alloy femoral head support device in the treatment of adult patients with avascular osteonecrosis of the femoral head. Methods The minimally-invasive approach involved curettage of the necrotic tissue of the femoral head, and a selfdesigned umbrella-shaped, memory alloy femoral head support device was implanted into the collapsed necrotic area to support the collapsed femoral head. Autologous iliac bone and artificial bone were implanted into the support device for the treatment of adult patients with avascular osteonecrosis of the femoral head. Results The clinical device was used in ten patients and 18 hip joints. The support device failed in one hip joint, which subsequently underwent joint replacement surgery, and the remaining 17 implanted devices were followed up for four to 19 months. The 17 postoperative hip joints were evaluated using the percent-efficacy evaluation method for avascular osteonecrosis of the femoral head in adult patients, and the efficacy rate was 82.35 %. ConclusionThe umbrella-shaped femoral head support device can be used in Ficat stage I, stage II, and stage III adult patients with avascular osteonecrosis of the femoral head.