TITLE

INFLUENCE OF ACETABULAR COVERAGE ON HIP SURVIVAL AFTER FREE VASCULARIZED FIBULAR GRAFTING FOR FEMORAL HEAD OSTEONECROSIS

AUTHOR(S)

Roush, Thomas F.; Olson, Steven A.; Pietrobon, Ricardo; Braga, Larissa; Urbaniak, James R.

PUB. DATE

October 2006

SOURCE

Journal of Bone & Joint Surgery, American Volume;Oct2006, Vol. 88-A Issue 10, p2152

SOURCE TYPE

Academic Journal

DOC. TYPE

Article

ABSTRACT

Background: Osteonecrosis of the femoral head frequently results in collapse of the head and subsequent arthrosis of the joint. Surgical treatment has been based entirely on the evaluation of the femoral side of the hip joint, with little consideration given to the possible influence on outcome of the orientation of the acetabulum. Methods: We retrospectively reviewed a consecutive series of 200 hips in 160 patients with osteonecrosis of the femoral head who had undergone free vascularized fibular grafting between 1997 and 1998. The mean duration of clinical follow-up was 7.5 years. Ninety-one hips in seventy-one patients were evaluated radiographically for evidence of progression of femoral head collapse at a minimum of two years, and a mean of three years, postoperatively. We defined conversion to a total hip arthroplasty and progression of femoral head collapse as the failure end points, and we analyzed the association of the acetabular center-edge angle of Wiberg, the area and laterality of the lesion, the amount of preoperative collapse of the femoral head, and the etiology of the osteonecrosis with the likelihood of failure. Results: Forty-eight (24%) of the 200 hips had undergone conversion to a total hip arthroplasty at the time of the final clinical follow-up. In addition, 15% (fourteen) of the ninety-one hips with sufficient radiographic follow-up demonstrated progression of femoral head collapse at the time of the final radiographic examination. Of the hips with a center-edge angle of ≤30°, 55% (of those with sufficient radiographic follow-up) demonstrated progressive collapse and 45% were converted to a total hip arthroplasty. In contrast, of the hips with a center-edge angle of >30°, 10% had progressive collapse (p = 0.002) and 6% were converted to a total hip arthroplasty (p < 0.001). Neither the etiology nor the size of the lesion was significantly correlated with progression of collapse or conversion to a total hip arthroplasty. Conclusions: Patients with osteonecrosis of the femoral head and a suboptimal center-edge angle of the hip are at substantial risk for progression of femoral head collapse and conversion to a total hip arthroplasty following free vascularized fibular grafting. An estimation of the degree of hip dysplasia should be included in the preoperative assessment of patients with osteonecrosis of the femoral head for prognostic and possibly surgical planning purposes.

ACCESSION #

22449142

 

Related Articles

• New Radiographic Index for Evaluating Acetabular Version. Koyama, Hiroshi; Hoshino, Hironobu; Suzuki, Daisuke; Nishikino, Shoichi; Matsuyama, Yukihiro // Clinical Orthopaedics & Related Research;May2013, Vol. 471 Issue 5, p1632 

  Background: Several qualitative radiographic signs have been described to assess acetabular retroversion. However, quantitative assessment of acetabular version would be useful for more rigorous research purposes and perhaps to diagnose and treat hip disorders. Questions/purposes: We developed a...

• Impaction Grafting for Acetabular Revision: Bringing Back the Bone. Argenson, Jean-Nöel; Paratte, Sebastien; Flecher, Xavier; Aubaniac, Jean-Manuel // Orthopedics;Sep2004, Vol. 27 Issue 9, p967 

  Reports the results of an experiment on the use of impaction grafting technique for acetabular with associated bone grafting and cemented polyethylene cup. Objectives of impaction grafting; Problems regarding cementless fixation of bones; Requirements for conducting the surgical technique;...

• The Wagner Spherical Osteotomy of the Acetabulum. Schramm, Michael; Hohmann, Dietrich; Radespiel-Troger, Martin; Pitto, Rocco Paolo // Journal of Bone & Joint Surgery, American Volume;Mar2004 Supplement 3, Vol. 86-A, p73 

  BACKGROUND: The purpose of this study was to evaluate the long-term clinical and radiographic results of spherical acetabular osteotomy, performed with the surgical technique described by Wagner, in patients with hip dysplasia. METHODS: The results of the first twenty-two spherical osteotomies...

• CT of the hips in the investigation of protrusio acetabuli in Marfan syndrome. A case control study. Lundby, Rigmor; Kirkhus, Eva; Rand-Hendriksen, Svend; Hald, John; Pripp, Are; Smith, Hans-Jørgen // European Radiology;Jul2011, Vol. 21 Issue 7, p1485 

  Objectives: To establish the prevalence of protrusio acetabuli (PA) in adults fulfilling the Ghent criteria for Marfan syndrome (MFS), and in a normal adult population. Methods: 105 adults with probable MFS and 107 controls were included. CT of the hips was obtained. A qualitative assessment of...

• Correlation of pelvic incidence with radiographical parameters for acetabular retroversion: a retrospective radiological study. Tiziani, Simon; Gautier, Lucienne; Farei-Campagna, Jan; Osterhoff, Georg; Jentzsch, Thorsten; Thi Dan Linh Nguyen-Kim; Werner, Clément M. L. // BMC Medical Imaging;9/30/2015, Vol. 15 Issue 1, p1 

  Background: Pelvic incidence (PI) has been linked to several degenerative processes within the spinopelvic system. Acetabular retroversion is a recognised risk factor for osteoarthritis of the hip. We therefore hypothesised that these two factors might be part of a specific anatomical variant...

• VASCULARIZED COMPARED WITH NONVASCULARIZED FIBULAR GRAFTS FOR LARGE OSTEONECROTIC LESIONS OF THE FEMORAL HEAD. Shin-Yoon Kim; Yong-Goo Kim; Poong-Taek Kim; Joo-Chul Ihn; Byung-Chae Cho; Kyung-Hoi Koo // Journal of Bone & Joint Surgery, American Volume;Sep2005, Vol. 87-A Issue 9, p2012 

  Background: Many authors have reported good results with the use of vascularized fibular grafts to treat large osteonecrotic lesions of the femoral head. To our knowledge, there have been no prospective case-controlled studies comparing the effectiveness of vascularized fibular grafting with...

• Hip joint remodeling in an adult following excision of a giant cell tumor involving the acetabulum: a case report and literature review. Nishida, Hideji; Tsuchiya, Hiroyuki; Yamamoto, Norio; Souza, Antonio; Tomita, Katsuro // Archives of Orthopaedic & Trauma Surgery;Sep2006, Vol. 126 Issue 7, p458 

  We describe a 47-year-old man with a giant cell tumor of bone involving the acetabulum treated with curettage and bone grafting which resulted in good remodeling of the hip joint. The patient had a 15 × 18-cm2 mass lesion extending from the right ischium to the acetabulum. Treatment included...

• Gelenkerhaltende Hüftchirurgie im Erwachsenenalter. Büchler, L.; Beck, M.; Gollwitzer, H.; Katthagen, B.D.; Zahedi, A.R. // Der Orthopäde;Nov2012, Vol. 41 Issue 11, p925 

  Deformity and malposition of the acetabulum can occur during the development of the hip. Developmental hip dysplasia and acetabular retroversion are possible causes of osteoarthritis in the young adult. Surgical management with reorientation of the acetabulum allows causal therapy of the...

• FEMORO-ACETABULAR IMPINGEMENT. Binningsley, David // SportEX Medicine;Apr2009, Issue 40, p10 

  The article offers information on the awareness and understanding of therapists in the pathology involved in femoroacetabular impingement (FAI). It states that FAI is a condition of too much friction in the hip joint. In notes that FAI generally occurs as two forms, Cam and Pincer. Cam describes...

Read the Article