Treatment of Large Osteonecrotic Lesions of the Femoral Head: Comparison of Vascularized Fibular Grafts with Nonvascularized Fibular Grafts

Abstract

To date, it has been recognized that large osteonecrotic lesions of the femoral head are the most difficult to treat effectively, regardless of the technique used. We compared vascular fibular grafting (VFG) with nonvascular fibular grafting (NVFG) in 19 patients (23 hips: 10 stage IIc hips, 2 stage IIIc hips, and 11 stage IVc hips) matched on the basis of stage, extent of lesions, etiology of the lesions, average age, and preoperative Harris hip score (HHS). The mean duration of follow-up was 4 years (minimum, 3 years; range, 3–5 years). Mean HHS of the stage IIc and IVc hips was significantly better in the VFG group. The rate of radiographic signs of progression and mean dome depression in all hips was significantly less in the VFG group. The conversion rate to total hip replacement (THR) in the VFG group was 13%; in the NVFG group, it was 24%. The Kaplan-Meier survivorship analysis revealed a 3-year survival rate of 91.3% (95% confidence interval, 85.4%–92.2%) for the VFG group and 78.3% (95% confidence interval, 69.7%–86.9%) for the NVFG group.