Comparison of Management of AVN of Femoral Head by Decompression with TFL Muscle Pedicle Bone Graft and Fibular Graft

Abstract

Background: Avascular necrosis (AVN) of the femoral head usually occurs in the active age of life, and is an increasingly common cause of musculoskeletal disability. Objective: we envisage to evaluate and compare the clinic oradiological outcomes between TFL muscle pedicle bone graft and no vascularized fibular grafting after core decompression prior to hip joint involvement of AVN femoral head provides painless and mobile life. Method: January 2013 to December 2019, total 64 hips (44 patients) in the age group of 18–48 years (mean 30.36±4.64 years) were included in this prospective study. Ficat and Arlet staging system was used, Stage I (n=10 hips), Stage II (n=44 hips) and stage III (n=10) of AVN of femoral head, were included after clinical and radiological evaluation, where 32 hips (half of all stage-I, II and III) were treated with fibular graft (Group 1) and rest 32 hips were treated with TFL muscle pedicle bone graft (Group 2) after decompression of femoral head. Preoperative Harris Hip Score (HHS), visual analog score (VAS), plain radiographs, and magnetic resonance imaging (MRI) were compared with serial postoperative HHS, VAS, plain radiographs at regular interval. The average follow up was 56 months. Result: Out of 44 patients, male was 28 (63.64%) and female was 16 (36.36%). Failure of surgery was defined as progression of the disease, which was n=1,10% (1/5, 20% in group 1, 0% in group-2) in stage I, n=12/44, 27.27% (7/22, 31.82% in group-1 and 5/22, 22.73% in group-2) in stage II and n=5/10, 50% (2/5, 40% in group 1 and 3/5, 60% in group 2) in stage III disease. Median values of HHS at the end of the follow up in Group I was 80 and 76 in Group 2, compared to the preoperative HHS of 56 and 52 respectively. Overall satisfactory result was 71.88%, p value was <0.01, that is significant. In group 1 satisfactory result was 22/32 (68.75%) but 24/32 (75%) in group 2, no statistical significant difference (>0.05) between two groups. Even in early stage III disease, only 50% was effective. Conclusion: Core decompression with bone graft is effective in preserving the sphericity of the femoral head and to delay the progression in the early stages of the AVN of femoral head, (Stage I and II), fibular graft gives early stability but long term results are similar in both group.