Follow-up Study on Allogeneic Nonvascularized Fibular Grafting in Treating Patients with Different Femoral Head Necrotic Area_West China Medical Journal

Authors：

 SUNMing-yao , WANGJun-bo , ZENGYi , PEIFu-xing ,  SHENBin

Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

SHENBin, Email: shenbin_1971@163.com

Keywords：

Osteonecrosis of femoral head; Nonvascularized fibular grafting; Necrotic area

DOI：

10.7507/1002-0179.20150412

Video：

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Objective To study the clinical efficacy of core decompression and allogeneic nonvascularized fibular grafting on patients with different femoral head necrotic area. Methods Between January 2010 and December 2011, 59 hips in 59 patients with Ficat stage Ⅱ osteonecrosis of femoral head were treated with core decompression and allogeneic nonvascularized fibular grafting. Fifty-four patients (54 hips) were followed up. According to the necrotic area of femoral head, patients were divided into three groups: 6 hips in type A, 37 hips in type B and 11 hips in type C. We analyzed the outcomes by changes in radiographic images, Harris hip scores, hip activity and visual analogue scale (VAS) pain scores. The mean follow-up time was 40.1 months. Results The postoperative X-ray images were good with no fibula prolapse, fracture or infection. Six femoral heads collapsed in patients of type C group. No head collapsed in patients grouped into type A or type B. The three groups' Harris hip scores were better than those before surgery (P<0.05). But the Harris hip score of patients with femoral head collapse was as bad as that before surgery (P>0.05). The Harris score of group C was significantly lower than group A and B (P<0.01). The joint movements of type A and type B patients were similar with those before surgery, and the VAS pain score was lower. But patients of type C suffered worse joint movement and the pain was not relieved. Conclusion The clinical efficacy of femoral head necrotic patients treated with core decompression and allogeneic nonvascularized fibular grafting is generally good. But the risk of femoral head collapse in type C patients is high, and the clinic outcome is worse than patients of type A and B. Therefore this type of surgery is more suitable for patients with type A and B femoral head necrotic area.

Citation： SUNMing-yao, WANGJun-bo, ZENGYi, PEIFu-xing, SHENBin. Follow-up Study on Allogeneic Nonvascularized Fibular Grafting in Treating Patients with Different Femoral Head Necrotic Area. West China Medical Journal, 2015, 30(8): 1430-1434. doi: 10.7507/1002-0179.20150412 Copy

1.	Malizos KN, Soucacos PN, Beris AE. Osteonecrosis of the femoral head. Hip salvaging with implantation of a vascularized fibular graft[J]. Clin Orthop Relat Res, 1995(314):67-75.
2.	Marcus ND, Enneking WF, Massam RA. Silent hip in idiopathic aseptic necrosis-treatment by bone-grafting[J]. J Bone Joint Surg Am, 1973, 55(7):1351-1366.
3.	Markel DC, Miskovsky C, Sculco TP, et al. Core decompression for osteonecrosis of the femoral head[J]. Clin Orthop, 1996(323):226-233.
4.	Smith SW, Meyer RA, Connor PM, et al. Interobserver reliability and intraobserver reproducibility of the modified Ficat classification system of osteonecrosis of the femoral head[J]. J Bone Joint Surg Am, 1996, 78(11):1702-1706.
5.	Sotereanos DG, Plakseychuk AY, Rubash HE. Free vascularized fibula grafting for the treatment of osteonecrosis of the femoral head[J]. Clin Orthop, 1997(344):243-256.
6.	Urbaniak JR, Coogan PG, Gunneson EB, et al. Treatment of osteonecrosis of the femoral head with free vascularized fibular grafting. A long-term follow-up study of one hundred and three hips[J]. J Bone Joint Surg Am, 1995, 77(5):681-694.
7.	González Della Valle A, Bates J, Di Carlo E, et al. Failure of free vascularized fibular graft for osteonecrosis of the femoral head: a histopathologic study of 6 cases[J]. J Arthroplasty, 2005, 20(3):331-336.
8.	Sugano N, Atsumi T, Ohzono K, et al. The 2001 revised criteria for diagnosis, classification, and staging of idiopathic osteonecrosis of the femoral head[J]. J Orthop Sci, 2002, 7(5):601-605.
9.	Tetik C, Başar H, Bezer M, et al.Comparison of early results of vascularized and non-vascularized fibular grafting in the treatment of osteonecrosis of the femoral head[J]. Acta Orthop Traumatol Turc, 2011, 45(5):326-334.
10.	康鹏德, 裴福兴, 沈彬, 等. 钻孔减压自体松质骨打压植骨结合同种异体腓骨棒植入治疗早期股骨头坏死的近期疗效观察[J]. 中华关节外科杂志:电子版, 2012, 6(2):17-21.
11.	Zhao DW, Zhang Y, Wang WM, et al. Tantalum rod implantation and vascularized iliac grafting for osteonecrosis of the femoral head[J]. Orthopedics, 2013, 36(6):789-795.
12.	Tanzer M, Bobyn JD, Krygier JJ, et al. Histopathologic retrieval analysis of clinically failed porous tantalum osteonecrosis implants[J]. J Bone Joint Surg Am, 2008, 90(6):1282-1289.
13.	Varitimidis SE, Dimitroulias AP, Karachalios TS, et al. Outcome after tantalum rod implantation for treatment of femoral head osteonecrosis 26 hips followed for an average of 3 years[J]. Acta Orthop, 2009, 80(1):20-25.
14.	Brunelli G, Brunelli G. Free microvascular fibular transfer for idiopathic femoral head necrosis:long-term follow-up[J]. J Reconstr Microsurg, 1991, 7(4):285-295.
15.	Aldridge J3. Avascular necrosis of the femoral head:role of vascularized bone grafts[J]. Orthop Clin North Am, 2007, 38(1):13-22.
16.	Judet H, Gilbert A. Long-term results of free vascularized fibular grafting for femoral head necrosis[J]. Clin Orthop Relat Res, 2001(386):114-119.
17.	Korompilias AV, Lykissas MG, Beris AE, et al. Vascularised fibular graft in the management of femoral head osteonecrosis:twenty years later[J]. J Bone Joint Surg Br, 2009, 91(3):287-293.
18.	Kane SM, Ward WA, Jordan LC, et al. Vascularized fibular grafting compared with core decompression in the treatment of femoral head osteonecrosis[J]. Orthopedics, 1996, 19(10):869-872.
19.	Buckley PD, Gearen PF, Petty RW. Structural bone-grafting for early atraumatic avascular necrosis of the femoral head[J]. J Bone Joint Surg Am, 1991, 73(9):1357-1364.
20.	Smith KR, Bonfiglio M, Montgomery WJ. Non-traumatic necrosis of the femoral head treated with tibial bone-grafting. A follow-up note[J]. J Bone Joint Surg Am, 1980, 62(5):845-847.
21.	Kim SY, Kim YG, Kim PT, et al. Vascularized compared with nonvascularized fibular grafts for large osteonecrotic lesions of the femoral head[J]. J Bone Joint Surg Am, 2005, 87(9):2012-2018.

1. Malizos KN, Soucacos PN, Beris AE. Osteonecrosis of the femoral head. Hip salvaging with implantation of a vascularized fibular graft[J]. Clin Orthop Relat Res, 1995(314):67-75.
2. Marcus ND, Enneking WF, Massam RA. Silent hip in idiopathic aseptic necrosis-treatment by bone-grafting[J]. J Bone Joint Surg Am, 1973, 55(7):1351-1366.
3. Markel DC, Miskovsky C, Sculco TP, et al. Core decompression for osteonecrosis of the femoral head[J]. Clin Orthop, 1996(323):226-233.
4. Smith SW, Meyer RA, Connor PM, et al. Interobserver reliability and intraobserver reproducibility of the modified Ficat classification system of osteonecrosis of the femoral head[J]. J Bone Joint Surg Am, 1996, 78(11):1702-1706.
5. Sotereanos DG, Plakseychuk AY, Rubash HE. Free vascularized fibula grafting for the treatment of osteonecrosis of the femoral head[J]. Clin Orthop, 1997(344):243-256.
6. Urbaniak JR, Coogan PG, Gunneson EB, et al. Treatment of osteonecrosis of the femoral head with free vascularized fibular grafting. A long-term follow-up study of one hundred and three hips[J]. J Bone Joint Surg Am, 1995, 77(5):681-694.
7. González Della Valle A, Bates J, Di Carlo E, et al. Failure of free vascularized fibular graft for osteonecrosis of the femoral head: a histopathologic study of 6 cases[J]. J Arthroplasty, 2005, 20(3):331-336.
8. Sugano N, Atsumi T, Ohzono K, et al. The 2001 revised criteria for diagnosis, classification, and staging of idiopathic osteonecrosis of the femoral head[J]. J Orthop Sci, 2002, 7(5):601-605.
9. Tetik C, Başar H, Bezer M, et al.Comparison of early results of vascularized and non-vascularized fibular grafting in the treatment of osteonecrosis of the femoral head[J]. Acta Orthop Traumatol Turc, 2011, 45(5):326-334.
10. 康鹏德, 裴福兴, 沈彬, 等. 钻孔减压自体松质骨打压植骨结合同种异体腓骨棒植入治疗早期股骨头坏死的近期疗效观察[J]. 中华关节外科杂志:电子版, 2012, 6(2):17-21.
11. Zhao DW, Zhang Y, Wang WM, et al. Tantalum rod implantation and vascularized iliac grafting for osteonecrosis of the femoral head[J]. Orthopedics, 2013, 36(6):789-795.
12. Tanzer M, Bobyn JD, Krygier JJ, et al. Histopathologic retrieval analysis of clinically failed porous tantalum osteonecrosis implants[J]. J Bone Joint Surg Am, 2008, 90(6):1282-1289.
13. Varitimidis SE, Dimitroulias AP, Karachalios TS, et al. Outcome after tantalum rod implantation for treatment of femoral head osteonecrosis 26 hips followed for an average of 3 years[J]. Acta Orthop, 2009, 80(1):20-25.
14. Brunelli G, Brunelli G. Free microvascular fibular transfer for idiopathic femoral head necrosis:long-term follow-up[J]. J Reconstr Microsurg, 1991, 7(4):285-295.
15. Aldridge J3. Avascular necrosis of the femoral head:role of vascularized bone grafts[J]. Orthop Clin North Am, 2007, 38(1):13-22.
16. Judet H, Gilbert A. Long-term results of free vascularized fibular grafting for femoral head necrosis[J]. Clin Orthop Relat Res, 2001(386):114-119.
17. Korompilias AV, Lykissas MG, Beris AE, et al. Vascularised fibular graft in the management of femoral head osteonecrosis:twenty years later[J]. J Bone Joint Surg Br, 2009, 91(3):287-293.
18. Kane SM, Ward WA, Jordan LC, et al. Vascularized fibular grafting compared with core decompression in the treatment of femoral head osteonecrosis[J]. Orthopedics, 1996, 19(10):869-872.
19. Buckley PD, Gearen PF, Petty RW. Structural bone-grafting for early atraumatic avascular necrosis of the femoral head[J]. J Bone Joint Surg Am, 1991, 73(9):1357-1364.
20. Smith KR, Bonfiglio M, Montgomery WJ. Non-traumatic necrosis of the femoral head treated with tibial bone-grafting. A follow-up note[J]. J Bone Joint Surg Am, 1980, 62(5):845-847.
21. Kim SY, Kim YG, Kim PT, et al. Vascularized compared with nonvascularized fibular grafts for large osteonecrotic lesions of the femoral head[J]. J Bone Joint Surg Am, 2005, 87(9):2012-2018.

West China Medical Journal

Follow-up Study on Allogeneic Nonvascularized Fibular Grafting in Treating Patients with Different Femoral Head Necrotic Area

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