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J Reconstr Microsurg 2013; 29(06): 387-392
DOI: 10.1055/s-0033-1343836
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Free Vascularized Fibular Grafting Benefits Severely Collapsed Femoral Head in Concomitant with Osteoarthritis in Very Young Adults: A Prospective Study

Hao Ding
1   Department of Orthopedic Surgery, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
,
You-Shui Gao
1   Department of Orthopedic Surgery, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
,
Sheng-Bao Chen
1   Department of Orthopedic Surgery, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
,
Dong-Xu Jin
1   Department of Orthopedic Surgery, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
,
Chang-Qing Zhang
1   Department of Orthopedic Surgery, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
› Author Affiliations
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Publication History

24 August 2012

07 December 2012

Publication Date:
15 April 2013 (online)

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Abstract

Although free vascularized fibular grafting (FVFG) has been successfully employed for precollapsed osteonecrosis of the femoral head (ONFH), there are few reports concerning its radiographic and functional results for ONFH concomitant with osteoarthritis (OA) of the hip. In the current study, 12 patients with OA induced by traumatic ONFH were enrolled, with FVFG employed as the treatment protocol. The collapsed step of the cartilage surface was measured and compared with the postoperative value, and the Merle d'Aubigné scoring system was used to evaluate preoperative and postoperative status of the hip joint. The collapsed step disappeared, and sphericity of the femoral head could be restored at an average duration of 56 months postoperatively in seven patients. With regard to the severity of hip OA, six were improved to Grade 1 and one to Grade 2. In terms of functionality, all patients with a restored femoral head experienced postoperative improvement in pain relief, mobility, and functional capacity. The average Merle d'Aubigné score increased from 6.0 to 16.9 postoperatively (p < 0.001). In conclusion, for traumatic ONFH concomitant with OA, FVFG can confer benefits in the form of restoration of the contour of the femoral head and improvement in joint function.

Keywords

free vascularized fibular grafting - osteonecrosis of the femoral head - osteoarthritis - femoral neck fractures - young adults
 

  • References

  • 1 Louie BE, McKee MD, Richards RR , et al. Treatment of osteonecrosis of the femoral head by free vascularized fibular grafting: an analysis of surgical outcome and patient health status. Can J Surg 1999; 42 (4) 274-283
    PubMedGoogle Scholar
  • 2 Coogan PG, Urbaniak JR. Role of free vascularized fibular bone grafting for osteonecrosis of the femoral head. Curr Orthop 1997; 11: 179-186
    CrossrefPubMedGoogle Scholar
  • 3 Marciniak D, Furey C, Shaffer JW. Osteonecrosis of the femoral head. A study of 101 hips treated with vascularized fibular grafting. J Bone Joint Surg Am 2005; 87 (4) 742-747
    CrossrefPubMedGoogle Scholar
  • 4 Korompilias AV, Beris AE, Lykissas MG, Kostas-Agnantis IP, Soucacos PN. Femoral head osteonecrosis: why choose free vascularized fibula grafting. Microsurgery 2011; 31 (3) 223-228
    CrossrefPubMedGoogle Scholar
  • 5 Petrigliano FA, Lieberman JR. Osteonecrosis of the hip: novel approaches to evaluation and treatment. Clin Orthop Relat Res 2007; 465: 53-62
    PubMedGoogle Scholar
  • 6 Lieberman JR, Berry DJ, Mont MA , et al. Osteonecrosis of the hip: Management in the twenty-first century. J Bone Joint Surg Am 2002; 84: 834-853
    CrossrefPubMedGoogle Scholar
  • 7 Zhang C, Zeng B, Xu Z , et al. Treatment of femoral head necrosis with free vascularized fibula grafting: a preliminary report. Microsurgery 2005; 25 (4) 305-309
    CrossrefPubMedGoogle Scholar
  • 8 Jun X, Chang-Qing Z, Kai-Gang Z, Hong-Shuai L, Jia-Gen S. Modified free vascularized fibular grafting for the treatment of femoral neck nonunion. J Orthop Trauma 2010; 24 (4) 230-235
    CrossrefPubMedGoogle Scholar
  • 9 Zhang CQ, Sun Y, Chen SB , et al. Free vascularised fibular graft for post-traumatic osteonecrosis of the femoral head in teenage patients. J Bone Joint Surg Br 2011; 93 (10) 1314-1319
    CrossrefPubMedGoogle Scholar
  • 10 Merle D'Aubigné R. [Numerical classification of the function of the hip. 1970]. Rev Chir Orthop Repar Appar Mot 1990; 76 (6) 371-374
    PubMedGoogle Scholar
  • 11 Soucacos PN, Beris AE, Malizos K, Koropilias A, Zalavras H, Dailiana Z. Treatment of avascular necrosis of the femoral head with vascularized fibular transplant. Clin Orthop Relat Res 2001; 386 (386) 120-130
    CrossrefPubMedGoogle Scholar
  • 12 Berend KR, Gunneson EE, Urbaniak JR. Free vascularized fibular grafting for the treatment of postcollapse osteonecrosis of the femoral head. J Bone Joint Surg Am 2003; 85-A (6) 987-993
    PubMedGoogle Scholar
  • 13 Bachiller FG, Caballer AP, Portal LF. Avascular necrosis of the femoral head after femoral neck fracture. Clin Orthop Relat Res 2002; (399) 87-109
    PubMedGoogle Scholar
  • 14 Assouline-Dayan Y, Chang C, Greenspan A, Shoenfeld Y, Gershwin ME. Pathogenesis and natural history of osteonecrosis. Semin Arthritis Rheum 2002; 32 (2) 94-124
    CrossrefPubMedGoogle Scholar
  • 15 Simon JP, Berger P, Bellemans J. Total hip arthroplasty in patients less than 40 years old with avascular necrosis of the femoral head. A 5 to 19-year follow-up study. Acta Orthop Belg 2011; 77 (1) 53-60
    PubMedGoogle Scholar
  • 16 Wilson A, Shehadeh LA, Yu H, Webster KA. Age-related molecular genetic changes of murine bone marrow mesenchymal stem cells. BMC Genomics 2010; 11: 229
    CrossrefPubMedGoogle Scholar
  • 17 Gala K, Burdzińska A, Idziak M, Makula J, Pączek L. Characterization of bone-marrow-derived rat mesenchymal stem cells depending on donor age. Cell Biol Int 2011; 35 (10) 1055-1062
    CrossrefPubMedGoogle Scholar
  • 18 Feng Y, Wang S, Jin D , et al. Free vascularised fibular grafting with OsteoSet®2 demineralised bone matrix versus autograft for large osteonecrotic lesions of the femoral head. Int Orthop 2011; 35 (4) 475-481
    CrossrefPubMedGoogle Scholar
  • 19 Wood MB. Free vascularized fibular grafting-25 years' experience: tips, techniques, and pearls. Orthop Clin North Am 2007; 38 (1) 1-12 , v
    CrossrefPubMedGoogle Scholar
  • 20 Davidovitch RI, Jordan CJ, Egol KA, Vrahas MS. Challenges in the treatment of femoral neck fractures in the nonelderly adult. J Trauma 2010; 68 (1) 236-242
    CrossrefPubMedGoogle Scholar