Treatment of osteonecrosis of the femoral head by free vascularized fibular grafting: An analysis of surgical outcome and patient health status

OBJECTIVE: TO evaluate the limb-specific outcome and general health status of patients with osteonecrosis of the femoral head treated with vascularize d fibular grafting, DESIGN: A retrospective review. SETTING: A single tertiary care centre, PATIENTS: Fifty-five consecutive patients with osteonecrosis of the femoral head who underwent fibular grafting (8 bilaterally). INTERVENTION: Vascularized fibular grafting. OUTCOME MEASURES: Limb-specific scores (Harris Hip Score, St. Michael's Hos pital Hip Score), general health status (Nottingham Health Profile, SF-36 h ealth status survey) and radiographic outcome measures (Steinberg stage). RESULTS: Patients were young (mean age 34 years, range from 18 to 52 years) and 80% had advanced osteonecrosis (Steinberg stages IV and V), Fifty-nine hips were followed up for an average of 50 months (range from 24 to 117 mo nths) after vascularized fibular grafting. Sixteen hips (27%) were converte d to total hip arthroplasty (THA). To date, 73% of hips treated with vascul arized fibular grafting have required no further surgery. Preoperative and postoperative Harris Hip Scores were 57.3 and 83.6 respectively (p < 0.001) , As measured by patient-oriented health status questionnaires (SF-36, Nott ingham Health Profile) and compared with population controls, patients had normal mental health scores and only slight decreases in physical component scores. CONCLUSIONS: Free vascularized fibular grafting for osteonecrosis of the fe moral head provides satisfactory pain relief, functional improvement and ge neral health status and halts the progression of symptomatic disease.