The Journal of Bone and Joint Surgery (American). 2005;87:742-747.
doi:10.2106/JBJS.D.02004
© 2005 The Journal of Bone and Joint Surgery, Inc.
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow [Supplementary Material]
Right arrow Letters to the Editor: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when Letters to the Editor are posted
Right arrow Alert me if a correction is posted
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrowReprints and Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Marciniak, D.
Right arrow Articles by Shaffer, J. W.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Marciniak, D.
Right arrow Articles by Shaffer, J. W.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us   Add to Technorati  
What's this?

Osteonecrosis of the Femoral Head

A Study of 101 Hips Treated with Vascularized Fibular Grafting

Donn Marciniak, MD1, Christopher Furey, MD1 and John W. Shaffer, MD1

1 The University Hospitals of Cleveland, 11100 Euclid Avenue, Cleveland, OH 44106. E-mail address for D. Marciniak: dam5{at}case.edu. E-mail address for C. Furey: christopher.furey{at}uhhs.com. E-mail address for J.W. Shaffer: shaffer46{at}msn.com

Investigation performed at the University Hospitals of Cleveland, Cleveland, Ohio

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).

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.

Background: The present study evaluates the minimum five-year results of vascularized fibular grafting for the treatment of osteonecrosis of the femoral head. The purposes of the present study were to review the results of fibular grafting in a large series of patients and to determine the indications for this procedure.

Methods: Eighty-six patients (101 hips) were followed clinically for a minimum of five years (or until the time of death). The study group included fourteen Marcus-Enneking stage-2 hips, twenty-three stage-3 hips, and sixty-four stage-4 hips. Three patients (three hips) died from unrelated causes before the five-year evaluation, and two patients (two hips) died after the five-year evaluation. Radiographic assessment was performed with use of the Marcus-Enneking grading system, and clinical assessment was performed with use of the Harris hip-scoring system. The end point was conversion to total hip arthroplasty. Patient satisfaction was also assessed.

Results: Sixty-two hips (61%) survived until the time of the five-year follow-up, and forty-two hips (42%) survived until the time of the interview (at a median of eight years postoperatively). The average Harris hip score was 58 ± 13 at the time of presentation and 80 ± 15 at five years. Eight (57%) of the Marcus-Enneking stage-2 hips, sixteen (70%) of the stage-3 hips, and thirty-eight (59%) of the stage-4 hips survived for at least five years. Of the eighty-one living patients (including forty-one who had a successful outcome and forty who had had a failure), forty-six patients (including twenty-one who had a successful outcome and twenty-five who had had a failure) stated that they would undergo the procedure again.

Conclusions: Vascularized fibular grafting may provide a chance for normal hip function in the intermediate or long term in carefully selected patients with osteonecrosis of the femoral head.

Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Technorati Technorati    What's this?


This article has been cited by other articles:


Home page
 JBJSHome page
B. J. McGrory, S. C. York, R. Iorio, W. Macaulay, R. R. Pelker, B. S. Parsley, and S. M. Teeny
Current Practices of AAHKS Members in the Treatment of Adult Osteonecrosis of the Femoral Head
J. Bone Joint Surg. Am., June 1, 2007; 89(6): 1194 - 1204.
[Abstract] [Full Text] [PDF]

Home page
 JBJSHome page
M. A. Mont, G. A. Marulanda, L. C. Jones, K. J. Saleh, N. Gordon, D. S. Hungerford, and M. E. Steinberg
Systematic Analysis of Classification Systems for Osteonecrosis of the Femoral Head
J. Bone Joint Surg. Am., November 1, 2006; 88(suppl_3): 16 - 26.
[Abstract] [Full Text] [PDF]

Home page
 JBJSHome page
M. A. Mont, L. C. Jones, and D. S. Hungerford
Nontraumatic Osteonecrosis of the Femoral Head: Ten Years Later
J. Bone Joint Surg. Am., May 1, 2006; 88(5): 1117 - 1132.
[Abstract] [Full Text] [PDF]

Home page
 J Bone Joint Surg BrHome page
S. B. Keizer, N. B. Kock, P. D. S. Dijkstra, A. H. M. Taminiau, and R. G. H. H. Nelissen
Treatment of avascular necrosis of the hip by a non-vascularised cortical graft
J Bone Joint Surg Br, April 1, 2006; 88-B(4): 460 - 466.
[Abstract] [Full Text] [PDF]