Vascularized fibular grafting has been used for treatment of osteonecrosis of the femoral head and although some reports demonstrate
successful short- to mid-term outcomes, long-term results are still unknown. We retrospectively reviewed 135 patients (151
hips) who underwent vascularized fibular grafting for osteonecrosis of the femoral head. One-hundred and ten patients (124
hips) were followed for a minimum 10 years (mean, 13.9 years; range, 10–23.7 years). The mean Harris hip score improved from
72 to 88. At the latest followup, we found improved or unchanged radiographs in 37 of 59 hips initially Stage II hips and
39 of 65 Stage III hips. Thirteen hips (13 patients) (10.5%) failed treatment and underwent total hip arthroplasty. The location
and size of the necrotic lesion and the patient’s age influenced long-term survival of the graft. Postoperative complications
included clawing of the big toe in 17 patients, partial peroneal nerve palsy in two, and superficial infection in two. Subtrochanteric
fracture occurred in two hips. The data suggest free vascularized fibular grafting was successful in maintaining joint function
and delaying the need for joint replacement procedure. Graft survival was associated with the patient’s age and size and location
of the lesion but not etiology and stages of the disease.
Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
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patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.
Each author certifies that his or her institution either has waived or does not require approval for the human protocol for
this investigation and that all investigations were conducted in conformity with ethical principles of research.