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The Journal of Bone and Joint Surgery (American) 85:589-596 (2003)
© 2003 The Journal of Bone and Joint Surgery, Inc.

Scientific Article

Vascularized Compared with Nonvascularized Fibular Grafting for the Treatment of Osteonecrosis of the Femoral Head

Anton Y. Plakseychuk, MD, PhD, Shin-Yoon Kim, MD, Byung-Chul Park, MD, Sokratis E. Varitimidis, MD, Harry E. Rubash, MD and Dean G. Sotereanos, MD

Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, and Kyungpook National University Hospital, Taegu, Korea

Anton Y. Plakseychuk, MD, PhD
Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, 3471 Fifth Avenue, Kaufmann Building, Suite 1010, Pittsburgh, PA 15213. E-mail address for A.Y. Plakseychuk: antonp{at}pitt.edu

Shin-Yoon Kim, MD
Byung-Chul Park, MD
Department of Orthopaedic Surgery, Kyungpook National University Hospital, 50, 2-Ga, SamDok-Dong, Taegu 700-721, Korea

Sokratis E. Varitimidis, MD
Department of Orthopaedics, University of Thessaly Medical School, 41110 Larissa, Greece

Harry E. Rubash, MD
Department of Orthopaedic Surgery, Massachusetts General Hospital, 55 Fruit Street, GRB 624, Boston, MA 02114

Dean G. Sotereanos, MD
Department of Orthopaedic Surgery, Allegheny General Hospital, 490 East North Avenue, Suite 500, Pittsburgh, PA 15212

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

A commentary is available with the electronic versions of this article, on our web site (www.jbjs.org) and on our quarterly CD-ROM (call our subscription department, at 781-449-9780, to order the CD-ROM).

Background: We are not aware of any clinical studies in the literature comparing the results of vascularized and nonvascularized fibular grafting for the treatment of osteonecrosis of the femoral head. The purpose of this study was to compare the clinical results of free vascularized fibular grafting with those of nonvascularized fibular grafting.

Methods: Two hundred patients (220 hips) with osteonecrosis of the femoral head were treated with free vascularized fibular grafting at the University of Pittsburgh Medical Center, and ninety-nine patients (123 hips) were treated with nonvascularized fibular grafting at the Kyungpook National University Hospital in Korea. From these populations, two groups of fifty hips each, followed for a minimum of three years (average, five years), were matched by the stage, size, and etiology of the lesion and by the mean preoperative Harris hip score. A retrospective case-control study of these groups was then performed to compare the postoperative Harris hip scores as well as the prevalences of radiographic progression and collapse of the femoral head following free vascularized fibular grafting with those measures following nonvascularized fibular grafting.

Results: The mean Harris hip score improved for 70% of the hips treated with free vascularized fibular grafting: seventeen hips (34%) were rated excellent, fourteen (28%) were rated good, nine (18%) were rated fair, and ten (20%) were rated poor. The mean Harris hip score improved for 36% of the hips treated with nonvascularized fibular grafting: five hips (10%) were rated excellent; nine (18%), good; sixteen (32%), fair; and twenty (40%), poor. The rate of survival at seven years for the Stage-I and II hips (precollapse) was 86% after treatment with free vascularized fibular grafting compared with 30% after nonvascularized fibular grafting.

Conclusions: The results of this study strongly suggest that vascularized fibular grafting is associated with better clinical and radiographic results.

Level of Evidence: Therapeutic study, Level III-2 (retrospective cohort study). See Instructions to Authors for a complete description of levels of evidence.



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