Kn. Malizos et al., 3-PHASE BONE SCANNING AND DIGITAL ARTERIOGRAMS FOR MONITORING VASCULARIZED FIBULAR GRAFTS IN FEMORAL-HEAD NECROSIS, International angiology, 14(3), 1995, pp. 319-326
In this prospective study the authors analysed the prognostic value of
monitoring patency of the feedings vessels of the fibular graft, impl
anted into the femoral head to treat aseptic necrosis. In 26 patients
(29 hips) we applied a three phase Tc-99-MDP Bone Scanning in the seve
nth postoperative day. One week later, 18 patients had a digital subtr
action angiography of the lateral femoral circumflex artery and its br
anches. The patients were followed for average time of 22 months. The
average Harris Hip Score of the affected hips improved clinically from
69.5 to 93.5. The vessels were patent prior to the wound closure. Pha
se I of the bone scan served as ''radionuclide angiogram'' and demonst
rated patent vessels in all about three hips. The digital arteriograms
demonstrated patent anastomotic sites in 15 out of 18 hips. Only in f
our of the fifteen arteriograms the vessels were visualized throughout
the length of the graft. Two of the three hips with negative arteriog
rams have also had negative bone scans, both in patients with haemoglo
binopathies. None of the patients required further surgery because of
failure of the procedure. This study demonstrated that the phase I of
the bone scan at the end of the first week postoperatively is very sen
sitive means for monitoring the viability of the graft. Digital arteri
ograms although more specific, were less sensitive. Early postoperativ
e monitoring of the graft viability maintained high predictive value f
or the outcome of the treatment in the medium-term.