Osteonecrosis of the Femoral Head: Comparison of Clinical Results for Vascularized Iliac and Fibula Bone Grafting

ABSTRACT

Thirty-three patients (39 hips) with avascular necrosis of the femoral head (ANFH), who received vascularized iliac pedicle bone grafting at the Orthopaedic Department of Linkou Medical Center, Chang-Gung Memorial Hospital, were followed for more than 4 years (Group 1). Twenty-two patients with ANFH, who received free vascularized fibula bone grafting (Group 2) were followed for more than 3 years. Six parameters were adopted to evaluate the outcomes in both groups. Study results for the parameters of postoperative functional score, patient-evaluated outcome, radiographic progression, and conversion to replacement arthroplasty were not significantly different. However, the mean operation time for Group 2 was significantly longer than that for Group 1 (7 hr vs. 3.5 hr) and the mean complication rate for Group 1 was higher than that for Group 2 (8/39 vs. 1/22). Since both are palliative procedures with almost equal success rates, the easier procedure was chosen and complications carefully avoided.

KEYWORDS

Osteonecrosis - femoral head

REFERENCES

• 1 Baksi D P. Treatment of osteonecrosis of the femoral head by drilling and muscle-pedicle bone grafting.  J Bone Joint Surg Br. 1991;  73 241-245
• 2 Bassett C AL, Schink-Ascani M, Lewis S M. Effects of pulsed electromagnetic fields on Steinberg rating of femoral head osteonecrosis.  Clin Orthop. 1989;  246 172-185
• 3 Boettcher W G, Bonfiglo M, Smith K. Non-traumatic necrosis of the femoral head. Part II. Experiences in treatment.  J Bone Joint Surg Am. 1970;  52 322-329
• 4 de Meulemeester F R, Rozing P M. Uncemented surface replacement for osteonecrosis of the femoral head.  Acta Orthop Scand. 1989;  60 425-429
• 5 Fujimaki A, Yamauchi Y. Vascularized fibular grafting for the treatment of aseptic necrosis of the femoral head-preliminary results in four cases.  Microsurgery. 1983;  4 17-22
• 6 Gilbert A, Judet H, Judet J, Ayatti A. Microvascular transfer of the fibula for necrosis of the femoral head.  Orthopedics. 1986;  9 885-890
• 7 Gottschalk F. Indications and results of intertrochanteric osteotomy in osteonecrosis of the femoral head.  Clin Orthop. 1989;  249 219-222
• 8 Leung P C. New method of hip reconstruction.  Orthop Rev. 1986;  15 3-12
• 9 Urbaniak J R, Coogan P G, Gunneson E B, Nunley J A. Treatment of osteonecrosis of the femoral head with free vascularized fibula grafting. A long-term follow-up study of one hundred and three hips.  J Bone Joint Surg Am. 1995;  77 681-694
• 10 Feng C K, Yu J K, Chang M C, Chen T H, Lo W H. Vascularized iliac bone graft for treating avascular necrosis of the femoral head.  Chin Med J (Taipei). 1998;  61 463-469
• 11 Hasegawa Y, Iwata H, Torii S, Iwase T, Kawamoto K, Iwasada S. Vascularized pedicle bone-grafting for non-traumatic avascular necrosis of the femoral head. A 5-11-year follow-up.  Arch Orthop Trauma Surg. 1997;  116 251-258
• 12 Leung P C. Femoral head reconstruction and revascularization. Treatment for ischemic necrosis.  Clin Orthop. 1996;  323 139-145
• 13 Plakseychuk A Y, Kim S Y, Park B C, Varitimidis S E, Rubash H E, Sotereanos D G. Vascularized compared with nonvascularized fibular grafting for the treatment of osteonecrosis of the femoral head.  J Bone J Surg Am. 2003;  85 589-596
• 14 Wassenaar R P, Verburg H, Taconis W K, van der Eijken J W. Avascular osteonecrosis of the femoral head treated with a vascularized iliac bone graft: preliminary results and follow-up with radiography and MR Imaging.  Radiographics. 1996;  16 585-594
• 15 Urbaniak J R, Harvey E J. Revascularization of the femoral head in osteonecrosis.  J Am Acad Orthop Surg. 1998;  6 44-54
• 16 Yen C Y, Lee S S, Yuan L J et al.. Vascularized island pedicle iliac bone grafting for avascular necrosis of the femoral head.  Chang Gung Med J. 2000;  23 536-541
• 17 Jacobs M A, Hungerford D S, Krackow K A. Intertrochanteric osteotomy for avascular necrosis of the femoral head.  J Bone Joint Surg Br. 1988;  70 761-766
• 18 Maistrelli G, Fusco U, Avai A, Bombelli R. Osteonecrosis of the hip treated by intertrochanteric osteotomy. A four-to 15-year follow-up.  J Bone Joint Surg Br. 1988;  70 761-766