This Article Full Text Full Text (PDF) CME: Take the activities for this article: CME 3: July, August, September 2005 Adult Hip Reconstruction Test 16: Fall 2005 [Supplementary Material] [Supplementary Material] Letters to the Editor: Submit a response Letters to the Editor: View responses Alert me when this article is cited Alert me when Letters to the Editor are posted Alert me if a correction is posted Services E-mail this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Rights and Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Kim, S.-Y. Articles by Koo, K.-H. Search for Related Content PubMed PubMed Citation Articles by Kim, S.-Y. Articles by Koo, K.-H. Related Collections Adult Hip Social Bookmarking                   What's this?

Vascularized Compared with Nonvascularized Fibular Grafts for Large Osteonecrotic Lesions of the Femoral Head

¹ Departments of Orthopaedic Surgery (S.-Y.K., Y.-G.K., P.-T.K., and J.-C.I.) and Plastic Surgery (B.-C.C.), Kyungpook National University Hospital, Sam Duck 2 Ga 50 Jung-Gu, Daegu 700-721, Republic of Korea. E-mail address for S.-Y. Kim: syukim{at}knu.ac.kr
² Department of Orthopaedic Surgery, Bundang Seoul National University Hospital, 300 Gumi-dong Bundang-gu, Seongnam, Gyunggi-do 463-703, Republic of Korea

Investigation performed at the Departments of Orthopaedic Surgery and Plastic Surgery, Kyungpook National University Hospital, Daegu, Republic of Korea

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.

Methods: Nineteen patients (twenty-three hips) with a large osteonecrotic lesion of the femoral head (Stage IIC in ten hips, Stage IIIC in two, and Stage IVC in eleven, according to the classification system of Steinberg et al.) underwent vascularized fibular grafting. This group was retrospectively matched according to the etiology, stage, and size of the lesion to a group of nineteen patients (twenty-three hips) who underwent nonvascularized fibular grafting during the same time period. A prospective case-controlled study of the two groups, with a mean duration of follow-up of four years, was then performed.

Results: The mean Harris hip score improved for 70% of the hips treated with a vascularized graft and 35% of the hips treated with a nonvascularized graft (p < 0.05). At the time of the final follow-up, nine of the ten hips with a Stage-IIC lesion treated with a vascularized fibular graft had not collapsed whereas seven of the thirteen hips with a larger lesion (Stage IIIC or IVC) had collapsed. Three hips (13%) were converted to a total hip replacement. The mean dome depression measured 2.8 mm. In the group treated with a nonvascularized graft, five of the ten Stage-IIC hips had not collapsed and eleven of the thirteen hips with a larger lesion had collapsed. Five (22%) of the hips were converted to a total hip replacement. The mean dome depression measured 4.3 mm. The rates of radiographic progression and collapse were significantly lower and the mean dome depression was significantly less in the group treated with a vascularized fibular graft (p < 0.05).

Conclusions: Vascularized fibular grafting was associated with better clinical results and was more effective than nonvascularized fibular grafting for the prevention of collapse of the femoral head in a matched population with a Steinberg Stage-IIC or larger osteonecrotic lesion. The results of vascularized grafting were best when the procedure was used to treat precollapse lesions (Steinberg Stage IIC).

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

CiteULike    Connotea    Del.icio.us    Facebook    Technorati    Twitter    What's this?

This article has been cited by other articles:

				C.-C. Chen, C.-L. Lin, W.-C. Chen, H.-N. Shih, S. W.N. Ueng, and M. S. Lee Vascularized Iliac Bone-Grafting for Osteonecrosis with Segmental Collapse of the Femoral Head J. Bone Joint Surg. Am., October 1, 2009; 91(10): 2390 - 2394. [Abstract] [Full Text] [PDF]

				M. E. Cabanela, M. A. Mont, M. G. Zywiel, and M. S. McGrath Total Hip Arthroplasty: Case-Based Panel Discussions J. Bone Joint Surg. Am., August 1, 2009; 91(Supplement_5): 15 - 16. [Abstract] [Full Text] [PDF]

				D. R. Marker, T. M. Seyler, M. S. McGrath, R. E. Delanois, S. D. Ulrich, and M. A. Mont Treatment of Early Stage Osteonecrosis of the Femoral Head J. Bone Joint Surg. Am., November 1, 2008; 90(Supplement_4): 175 - 187. [Full Text] [PDF]

				C.-J. Wang, F.-S. Wang, J.-Y. Ko, H.-Y. Huang, C.-J. Chen, Y.-C. Sun, and Y.-J. Yang Extracorporeal shockwave therapy shows regeneration in hip necrosis Rheumatology, April 1, 2008; 47(4): 542 - 546. [Abstract] [Full Text] [PDF]

				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]

				K. M. Huffman, J. R. Bowers, Z. Dailiana, J. L. Huebner, J. R. Urbaniak, and V. B. Kraus Synovial fluid metabolites in osteonecrosis Rheumatology, March 1, 2007; 46(3): 523 - 528. [Abstract] [Full Text] [PDF]

				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]

				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]

Letters to the Editor:

Stanford University Libraries' HighWire Press (TM) assists in the publication of JBJS Online.
Copyright © 2005 by The Journal of Bone and Joint Surgery, Inc. Online ISSN: 1535-1386.
The Journal of Bone and Joint Surgery®, JBJS®, JB&JS®, and eJBJS® are registered in the U.S. Patent and Trademark Office.