- Discussion: -
Fibular Harvest: -
Hip Preparation: Various methods have been advocated for the treatment of acascular necrosis of the hip in the young patient. From the literature an operative treatment for the symptomatic hip is the conservative method of management. Reports on core decompression, osteotomies, electrical stimulation, and bone grafting have been difficult to interperate. There are few prospective controlled studies in the literature. Vascularized bone grafting has had the most consistent successful results. Morbidity of the donor site is minimal and the time for the operation is comparable to that for a total hip arthroplasty. The graft does have a longer rehabilitation time and does not afford as complete pain relief as a total hip arthroplasty. When compared to a total hip arthroplasty the vascularized fibular graft has several advantages. The presence of a fibular graft does not preclude the later conversion to a total hip arthroplasty, and the operation is easier than after hip osteotomies, and certainly a much more desirable operation than an early hip revision. There is no increased risk of infection. If the procedure is done before collapse there is a chance that the graft will be viable for the life of the patient. Extracapsular free vascularized fibular grafting is the treatment of choice for AVN of all grades in the young patient at our institution. The graft, theoretically, treats many of the ongoing processes of osteonecrosis. It allows decompression of the femoral head in an effort to halt the ischemia due to increased interosseous pressure. Necrotic bone which can inhibit healing is removed and replaced with cancellous bone which has osteoinductive and conductive factors. The cortical strut supplies a basis of reinforcement for the subchondral bone and the vascular pedicle guarantees a supply of nutrients and blood to the healing femoral head. Medium term follow up has indicated that the procedure has proven its efficacy for almost all grades of osteonecrosis of the hip.
- references: -
Idiopathic Bone Necrosis of the Femoral Head; Early Diagnosis and Rx; -
Structural Bone-Grafting for Early Atraumatic Avascular Necrosis of the Femoral Head. - Vascularized fibular grafting compared with core decompression in the treatment of femoral head osteonecrosis. Kane SM. Ward WA. Jordan LC. Guilford WB. Hanley EN Jr. Orthopedics. 19(10):869-72, 1996 Oct. -
Results of transtrochanteric rotational osteotomy for femoral head osteonecrosis. -
Indications and results of intertrochanteric osteotomy in osteonecrosis of the femoral head. -
A finite-element analysis of the effects of intertrochanteric osteotomy on stresses in femoral head osteonecrosis. -
Transtrochanteric anterior rotational osteotomy for idiopathic and steroid-induced necrosis of the femoral head. Indications and long-term results. -
Transtrochanteric anterior rotational osteotomy for avascular necrosis of the femoral head. Long-term results. -
Intertrochanteric osteotomy and autogenous bone-grafting for avascular necrosis of the femoral head. -
Treatment of osteonecrosis of the femoral head with free vascularized fibular grafting. A long-term follow-up study of one hundred and three hips. -
Osteonecrosis of the femoral head. Hip salvaging with implantation of a vascularized fibular graft. -
Free vascularized fibula grafting for the treatment of osteonecrosis of the femoral head. -
Transfer of vascularized grafts of iliac bone to the extremities. -
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