VASCULARIZED FIBULAR GRAFTING COMPARED WITH CORE DECOMPRESSION IN THETREATMENT OF FEMORAL-HEAD OSTEONECROSIS

A prospective study was undertaken to compare vascularized fibular gra fting (VFG) with core decompression for Ficat Grade II and III femoral head osteonecrosis. The study group included 39 hips in 34 patients-2 0 VFGs and 19 core decompressions. Independent evaluation of results w as performed by an orthopedic surgeon and a radiologist at a minimum o f 2 years postoperatively (range: 2 to 5 years). Disease extent was as sessed by Ficat radiographic gradings. VFGs failed (conversion to tota l hip arthroplasty for functionally incapacitating pain) at a rate of 20%, significantly lower than the 58% failure rate of core decompressi ons (P = .025). Complications included 2 proximal femur fractures in e ach group, ankle pain in 6 VFGs, and graft vessel thrombosis in 1 VFG. Vascularized fibular grafting appears superior to core decompression in prolonging hip joint survivorship for Ficat Grades II and III femor al head osteonecrosis.