SURVIVAL ANALYSIS OF HIPS TREATED WITH CORE DECOMPRESSION OR VASCULARIZED FIBULAR GRAFTING BECAUSE OF AVASCULAR NECROSIS

Avascular necrosis of the femoral head is a multifaceted profess that leads to articular incongruity and subsequent osteoarthrosis of the jo int. Clinicians concur that primary treatment should focus on preserva tion of the natural surface of the joint; however, there has not been a consensus on how best to accomplish this. While a number of therapeu tic interventions have been reported, the efficacy has varied markedly and there have been few statistical comparisons. The purpose of the c urrent study was to use statistical analysis to compare the results of two widely used procedures, vascularized fibular grafting (614 hips; 480 patients) and core decompression (ninety-eight hips; seventy-two p atients), for the treatment of avascular necrosis, The patients mere s tratified according to age and the stage of disease, and a survival an alysis was performed with total hip arthroplasty as the end point for failure, None of the eleven hips that had Ficat stage-I disease needed a total joint replacement after being treated with either regimen, An alysis of the hips that had stage-II disease revealed rates of surviva l, at fifty months, of 65 per cent (twenty-eight of forty-three hips) after core decompression and 89 per cent (ninety-nine of 111 hips) aft er vascularized fibular grafting, For the hips that had Ficat stage-II I disease, the rates of survival at fifty months were 21 per cent (ten of forty-seven hips) after core decompression and 81 per cent (405 of 500 hips) after vascularized fibular grafting, Among the hips that ha d Ficat stage-II or LII disease, the rate of eventual total joint arth roplasty after vascularized fibular grafting was significantly lower t han that after core decompression (p < 0.0001), The results indicate t hat the increased morbidity associated with vascularized fibular graft ing is justified by the associated delay in or prevention of articular collapse in hips that have stage-II or III disease.