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. 2020 Mar 24;15(1):116.
doi: 10.1186/s13018-020-1565-3.

Mid- to long-term results of modified non-vascularized allogeneic fibula grafting combined with core decompression and bone grafting for early femoral head necrosis

Chen Changjun  1 , Li Donghai  1 , Zhao Xin  1 , Chen Liyile  1 , Wang Qiuru  1 , Kang Pengde  2
Affiliations

Mid- to long-term results of modified non-vascularized allogeneic fibula grafting combined with core decompression and bone grafting for early femoral head necrosis

Chen Changjun et al. J Orthop Surg Res. .

Abstract

Purpose: The aim of this study was to determine mid-and-long term follow-up results of patients with early femoral head osteonecrosis who were treated by modified free vascularized fibular grafting combined with core decompression and bone grafting.

Methods: Forty-four patients at early ONFH were included in this study. Visual analog scale (VAS) pain scores, range of hip motion (ROM), and Harris hip score (HHS) were recorded to assess the clinical outcome; Western Ontario McMaster Osteoarthritis index (WOMAC) scores and Short Form 36 health survey (SF-36) were conducted to measure the living quality; X-ray film or magnetic resonance imaging (MRI) was used to evaluate radiographic progression; survivorship was defined as patients did not undergo the total hip arthroplasty (THA) or fusion at the last follow-up. Median follow-up was 7.4 years (6-8.2 years).

Results: The mean VAS score, ROM, and HHS were significantly improved at the final follow-up compared with preoperative values (p < 0.001). Health assessment including WOMAC scores and SF-36 were also better than those preoperatively (p < 0.001). Seven patients progressed to Ficat III and the four patients progressed to Ficat IV with osteoarthritis. Eight patients who cannot tolerate the pain and had poor living quality underwent THA.

Conclusion: Modified non-vascularized allogeneic fibula Grafting combined with core decompression and bone grafting could improve the clinical outcomes and enhance the quality of life for patients with early ONFH.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
a The nonvascularized allogeneic fibula with 10 cm long and small holes on the surface. b Removed the dead bone through the decompression channel. c, d Diagrammatic drawing of the decompression channel. c Creating the decompression channel during the operation. d The channel has been built and an allogeneic fibula has been grafted
Fig. 2
Fig. 2
The radiographic outcomes of a 36-year-old man with a long history of drinking and was diagnosed as left femoral head necrosis at Ficat II stage. A1–A5 The patient has early femoral head necrosis evaluated by X film and MRI respectively. B1–B3 The X film of 3 days after the operation. It shows that the femoral head is in normal shape and the grafted fibula integrates tightly in the channel. C, D The images at 1 and 4 months after the operation, respectively. E1–E3 The images at 2 years after the operation. F1–F3 The images at 5 years after the operation, which shows the stability of the articular cartilage and femoral head. G1–G3 The images at 8.2 years after the operation. The femoral head is not progressed and keeps in good shape. The left femoral head was in Ficat I stage and the Harris score was 90 at the last follow-up
Fig. 3
Fig. 3
The radiographic outcomes of a 36 years old man with a long history of drinking and was diagnosed as left femoral head necrosis at Ficat II stage. A1–A5 The patient has early femoral head necrosis evaluated by X film and MRI respectively. B1–B3 The X film of 3 days after the operation. It shows that the femoral head is in normal shape and the grafted fibula integrates tightly in the channel. C, D The images at 1 and 4 months after operation respectively. E1–E3 The images at 2 years after the operation. F1–F3 The images at 5 years after the operation, which shows the stability of the articular cartilage and femoral head. G1–G3 The images at 8.2 years after the operation. The femoral head is not progressed and keeps in good shape. The left femoral head was in Ficat I stage and the Harris score was 90 at the last follow-up
See this image and copyright information in PMC

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