Treatment of osteonecrosis in the hip of pediatric patients by free vascularized fibular graft

The purpose of the current study was to review the demographics and etiolog ies of symptomatic femoral head osteonecrosis in the pediatric and adolesce nt population and to assess the results of treatment using free vascularize d fibular grafting. A group of patients with femoral head osteonecrosis who were treated with free vascularized fibular grafting was reviewed. Patient s who were studied were 18 years of age or younger at the time of surgery. Records were examined for demographic data, etiology of osteonecrosis, stag e of the disease at time of surgery, and results of treatment including pre operative and postoperative Harris hip scores. Eighty-two pediatric and ado lescent patients with osteonecrosis of the femoral head underwent 90 free v ascularized fibular grafting procedures. Fifty patients (54 hips) who have been followed up at least 2 or more years (average, 4.3 years) constituted the study group. At the last followup, total hip arthroplasty was performed in seven hips (seven patients) and hip fusion was performed in one hip (on e patient). The average Harris hip scores in patients who did not undergo t otal hip arthroplasty improved from a preoperative average of 55.3 points t o 90.2 points at the latest followup. Treatment of patients with osteonecro sis with free vascularized fibular grafting resulted in a lower rate of con version to total hip arthroplasty or fusion (16%) in pediatric and adolesce nt patients when compared with conversion to total hip arthroplasty in adul ts (25%). The quality of life as evidenced by the increased Harris hip scor es was improved significantly in this group of pediatric and adolescent pat ients.