FREE VASCULARIZED FIBULA GRAFTING FOR THE TREATMENT OF OSTEONECROSIS OF THE FEMORAL-HEAD

Sixty-five patients (88 hips) who received free vascularized fibula gr afting for treatment of osteonecrosis of the femoral head at the Unive rsity of Pittsburgh Medical Center, were followed for at least 3 years (average followup, 5.5 years; range, 3-7 years). There were 46 men an d 19 women with an average age of 37 years (range, 20-52 years). All p atients were evaluated using history, physical examination, Harris Hip Score, anteroposterior and lateral radiographs, and magnetic resonanc e images, The classification system of Steinberg et al (1995) was used to stage the disease. At final evaluation, 31 hips (35.2%) were rated excellent (Harris Hip Score >90 points, minimal or no pain), 30 hips (34.1%) were rated good (Harris Hip Score 80-89 points, slight pain), seven hips (8%) were rated fair (Harris Hip Score 70-79, slight or mod erate pain), and 20 hips (22.7%) were rated poor (Harris Hip Score <70 , pain). Twenty hips in 17 patients required total hip arthroplasty. I n the remaining hips, the disease apparently arrested and the contour of the femoral head was preserved. Kaplan-Meier survivorship analyses showed that the probability of conversion to total hip arthroplasty wi thin an average of 5.5 years after free vascularized fibula grafting w as 28% for Stage II hips and 38% for Stages III and IV hips. The hip s urvival rate for subgroups at 5.5 years was 100% for Stages IC and IIA , 94% for Stage IIB, 50% for Stage IIC, 80% for Stage IIIB, 58% for St age IIIe, 72% for Stage IVA, and 58% for Stage IVB. Free vascularized fibula grafting is a reliable operation and can preserve hip function and diminish pain successfully.