Free Vascularized Fibular Transfer for Femoral Head Osteonecrosis: Donor and Graft Site Morbidity

Gaskill, Trevor R.; Urbaniak, James R.; Aldridge III, J. Mack
August 2009
Journal of Bone & Joint Surgery, American Volume;Aug2009, Vol. 91-A Issue 8, p1861
Academic Journal
Background: Autogenous vascularized fibular transfer is used effectively for a variety of complex reconstructive procedures. Published series demonstrating the morbidity associated with its harvest have, understandably, been relatively small, and graft site (hip) complications have not been reported. This report describes both the donor and the graft site morbidity associated with use of vascularized fibular transfer to treat osteonecrosis of the femoral head. Methods: Between 1990 and 2006, 1270 free vascularized fibular grafts were used to treat osteonecrosis of the femoral head in 946 consecutive patients. All procedures and follow-up examinations were performed by one of two surgeons. Subjective and objective findings were recorded on standardized examination sheets at routine postoperative intervals. Data were analyzed to determine the morbidity associated with donor and graft sites. Results: There were 215 complications (a 16.9% rate) at the time of follow-up, at an average of 8.3 years, after the 1270 procedures. Of these complications, 146 (11.5%) and sixty-nine (5.4%) were referable to the donor and graft sites, respectively. A major complication requiring an additional surgical procedure or chronic pain management occurred after fifty-four (4.3%) of the 1270 procedures. Conclusions: A measurable but acceptable morbidity risk is associated with vascularized fibular transfer for the treatment of osteonecrosis of the hip. Major complications are not frequent, and many minor complications are transient and improve over time. Risks can be minimized when specific technical principles are followed. Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.


Related Articles

  • Osteonecrosis of the Femoral Head Linked to Topical Steroids for Skin Bleaching: A Case Report. Felten, Renaud; Messer, Laurent; Moreau, Paul; Goussot, Raphaelle; Mahé, Antoine // Annals of Internal Medicine;11/18/2014, Vol. 161 Issue 10, p763 

    The article presents a case study of a 26-year-old man who had a 1-year history of pain in the right hip and was later found to have advanced osteonecrosis of the femoral head.

  • POST-FRACTURE PAIN RELIEF. DAVIS, JENNIFER // Arthritis Today;Nov/Dec2011, Vol. 25 Issue 6, p59 

    The article offers information on a study conducted by researchers in the U.S., which reveals that it is difficult for an arthritis patient to gain hip pain relief after a fracture.

  • Contrast-enhanced MR imaging of subchondral insufficiency fracture of the femoral head: a preliminary comparison with that of osteonecrosis of the femoral head. Miyanishi, Keita; Hara, Toshihiko; Kaminomachi, Shigekazu; Maeda, Hiroki; Watanabe, Hideyuki; Torisu, Takehiko // Archives of Orthopaedic & Trauma Surgery;May2009, Vol. 129 Issue 5, p583 

    Subchondral insufficiency fracture of the femoral head (SIF) may be confused with osteonecrosis of the femoral head (ON) due to clinical and imaging similarities. Contrast-enhanced MR images in patients with SIF (ten hips in ten patients) were retrospectively reviewed and compared with those...

  • Transtrochanteric rotational osteotomy for avascular necrosis of the femoral head after unstable slipped capital femoral epiphysis: 10-year clinical results. Nakashima, Yasuharu; Yamamoto, Takuaki; Fukushi, Jun-Ichi; Motomura, Goro; Hamai, Satoshi; Kohno, Yusuke; Iwamoto, Yukihide // Journal of Orthopaedic Science;Nov2016, Vol. 21 Issue 6, p831 

    Background: Avascular necrosis of the femoral head (AVN) is the most serious complication after unstable slipped capital femoral epiphysis (SCFE), and is often unsalvageable. We report a minimum 10 years of clinical results for transtrochanteric rotational osteotomy of the femoral...

  • Nonunion paediatric femoral neck fracture treatment without open reduction. Perajit Eamsobhana; Kamolporn Keawpornsawan // Hip International;Nov/Dec2016, Vol. 26 Issue 6, p608 

    Fractures of the proximal femur account for less than 1% of all children's fractures. Because of this, most orthopaedic surgeons lack enough experience in treating them. This adds to the rather high incidence of complications especially nonunion. At the time of this review there is no consensus...

  • HIP PAIN. CAMP, MICHAEL // Joe Weider's Muscle & Fitness;Apr2012, Vol. 73 Issue 4, p68 

    The article offers suggestions to treat and prevent hip pain after performing heavy squats. It is stated that a sharp ache in hip joints is observed after doing squats, whih could be tightness in the hip flexors. It is recommended to take three to four weeks off from squatting and perform other...

  • Manipulative Treatment of Hip Pain in a Ballet Student. Whipple, Tom; Plafcan, Dean; Sebastianelli, Wayne J. // Journal of Dance Medicine & Science;2004, Vol. 8 Issue 2, p53 

    A 14-year-old female ballet student was referred to physical therapy for examination and treatment of left inguinal region pain. A single session of non-thrust manipulation resulted in an immediate and lasting improvement in symptoms. This case report includes description of the relevant...

  • Undermedication for Pain and Precipitation of Delirium. Robinson, Sherry; Vollmer, Charlene // MEDSURG Nursing;Mar/Apr2010, Vol. 19 Issue 2, p79 

    Introduction Review of the literature revealed an association of pain and delirium in patients with hip fracture. Literature was sparse on pain and delirium in other types of patients. Purpose The purpose of this study was to determine if there was a difference in the amount of analgesia...

  • Pain relief pioneers. Pearce, Lynne // Nursing Standard;3/27/2013, Vol. 27 Issue 30, p23 

    Lynne Pearce reports on a nurse-led service that helps patients with a hip fracture recover more quickly.


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics