scholarly journals Histopathological Findings of Failed Free Vascularized Fibular Grafting for Osteonecrosis of the Femoral Head after Long-Term Follow-Up

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Thou Lim ◽  
Qian Tang ◽  
Qiyang Wang ◽  
Zhenzhong Zhu ◽  
Xiaojuan Wei ◽  
...  
Keyword(s):  
Articular Cartilage ◽  
Femoral Head ◽  
Trabecular Bone ◽  
Necrotic Lesion ◽  
Host Bone ◽  
Fibular Graft ◽  
Tissue Invasion ◽  
Fibular Grafting ◽  
Free Vascularized Fibular Grafting

Purpose. The aim of this study was to report the histopathology of failed free vascularized fibular grafting (FVFG) for osteonecrosis of the femoral head (ONFH) after a mean follow-up of 11.5 years (ranged from 10.6 to 14.2 years). Methods. Six hips of 5 patients with a history of steroid use, aged 34–67 years, were in stage II of ONFH as classified by the Ficat and Arlet classification at the time of FVFG treatment. Grafting failure led to osteoarthritis of the hip joint during a mean of 11.5 years of follow-up. Femoral head specimens were first evaluated macroscopically. Bone specimens were sectioned into long strips, divided into necrotic, transitional, and healthy zones, and then prepared for nondecalcified and decalcified histopathological examination using hematoxylin and eosin (HE) staining, Goldner’s trichrome staining, and immunofluorescence (IF) staining. Results. Femoral head articular cartilage surfaces appeared thin, opaque, and partially cartilaginous missing, with gradual collapse detected in weight-bearing areas. The interface with the fibular graft showed well union, with no obvious gaps between graft and host bone, as observed macroscopically. The necrotic area was filled with fibular graft, cancellous bone, and cartilaginous or soft tissue invasion. Histopathology results revealed well integration between fibular graft and host bone, with thickened trabecular bone. Gaps occurred in transitional and healthy zones. In the necrotic zone, cartilaginous or soft tissue invasion occurred, while thin or missing articular cartilage exposed subchondral bone to hip joint surfaces. By IF counterstaining with CD-31 and α-SMA, blood vessel transplanted during fibular grafting could be clearly observed along the graft from healthy to necrotic zones. In the necrotic zone, blood vessels presented obviously and spread into the surrounding area of the graft tip. Conclusion. After FVFG procedure with a mean follow-up of 11.5 years, fibular grafts retained their integrity as viable, vascularized, cortical bone that fused well with host bone and formed thickened trabecular bone surrounding the surface of the graft. However, the revascularization of FVFG’s blood vessels spreading from the tip of the fibular graft into subchondral area of necrotic lesion did not improve significantly in these failure cases. The local necrotic lesion failed to be repaired as healthy trabecular bone to buttress articular surface and was occupied by soft tissues.

scholarly journals The Effect of Postoperative Corticosteroid Administration on Free Vascularized Fibular Grafting for Treating Osteonecrosis of the Femoral Head

2013 ◽  
Vol 2013 ◽  
pp. 1-5
Author(s):  
Hao Ding ◽  
Sheng-Bao Chen ◽  
Sen Lin ◽  
You-Shui Gao ◽  
Chang-Qing Zhang
Keyword(s):  
Adverse Effect ◽  
Femoral Head ◽  
Harris Hip Score ◽  
Radiographic Evaluation ◽  
Control Group ◽  
Corticosteroid Administration ◽  
The Mean ◽  
Fibular Grafting ◽  
Free Vascularized Fibular Grafting

Free vascularized fibular grafting (FVFG) has been reported to be an effective method of treating osteonecrosis of the femoral head (ONFH). This study evaluated whether postoperative maintenance doses of corticosteroids had an adverse effect on FVFG outcomes in patients with corticosteroid-induced ONFH. We retrospectively reviewed the records of 39 patients (67 hips) who had received maintenance doses of corticosteroids following FVFG. This group was matched to a group of patients who had not received corticosteroids treatment after operation. The mean follow-up duration was 5.4 years for the postoperative corticosteroid administration group (PCA group) and 5.0 years for the control group. At the latest follow-up, the average increase in Harris hip score was 11.1 ± 8.7 points for all hips in the PCA group and 12.6 ± 7.4 points for all hips in the control group (P>0.05). In the PCA group, through radiographic evaluation, 49 hips were improved, 10 hips appeared unchanged, and 8 hips appeared worse. In the control group, 47 hips were improved, 13 hips appeared unchanged, and 7 hips appeared worse. The results suggested that postoperative maintenance doses of corticosteroids do not have an adverse effect on FVFG outcomes in patients with corticosteroid-induced ONFH.

scholarly journals Treatment of osteonecrosis of the femoral head with free vascularized fibular grafting: Results of 7.6-year follow-up

2016 ◽  
Vol 50 (5) ◽  
pp. 501-506 ◽  
Author(s):  
Mehmet Bekir Ünal ◽  
Eren Cansu ◽  
Fatih Parmaksızoğlu ◽  
Hakan Cift ◽  
Serkan Gürcan
Keyword(s):  
Femoral Head ◽  
Fibular Grafting ◽  
Free Vascularized Fibular Grafting

Free vascularized fibular graft for treatment of pathological femoral neck fracture and osteonecrosis of the femoral head: A case report with a long-term follow-up

Microsurgery ◽  
2008 ◽  
Vol 29 (3) ◽  
pp. 240-243 ◽  
Author(s):  
Alexandros E. Beris ◽  
Marios G. Lykissas ◽  
Alexandros Payatakes ◽  
Vasileios A. Kontogeorgakos ◽  
Alexandros Mavrodontidis ◽  
...  
Keyword(s):  
Case Report ◽  
Femoral Head ◽  
Femoral Neck ◽  
Fibular Graft ◽  
Vascularized Fibular Graft ◽  
Long Term Follow Up ◽  
Neck Fracture ◽  
Free Vascularized Fibular Graft

Why we choose free vascularized fibular grafting for osteonecrosis of the femoral head?

Microsurgery ◽  
2011 ◽  
Vol 31 (5) ◽  
pp. 417-418 ◽  
Author(s):  
Chang-Qing Zhang ◽  
You-Shui Gao ◽  
Zhen-Hong Zhu ◽  
Xiao-Wei Yu
Keyword(s):  
Femoral Head ◽  
Fibular Grafting ◽  
Free Vascularized Fibular Grafting

scholarly journals Indications for free vascularized fibular grafting for the treatment of osteonecrosis of the femoral head

2007 ◽  
Vol 8 (1) ◽  
Author(s):  
Kenji Kawate ◽  
Hiroshi Yajima ◽  
Kazuya Sugimoto ◽  
Hiroshi Ono ◽  
Tetsuji Ohmura ◽  
...  
Keyword(s):  
Femoral Head ◽  
Fibular Grafting ◽  
Free Vascularized Fibular Grafting

scholarly journals Long-term Survival and Clinical Outcomes of Non-vascularized Autologous and Allogeneic Fibular Grafts are Comparable for Treating Osteonecrosis of the Femoral Head

2020 ◽  
Author(s):  
Ke Jie ◽  
Wenjun Feng ◽  
Feilong Li ◽  
Keliang Wu ◽  
Jinlun Chen ◽  
...  
Keyword(s):  
Survival Rate ◽  
Femoral Head ◽  
Clinical Outcomes ◽  
Harris Hip Score ◽  
Fibular Graft ◽  
Vas Score ◽  
Long Term Follow Up ◽  
Group A

Abstract Background Osteonecrosis of the femoral head (ONFH) is a disabling disease, which often involves young patents. Recently, various hip-preserving surgeries were recommended to delay total hip arthroplasty (THA).Questions/purposes This study aimed to compare clinical outcomes and survival rate in the long-term follow-up between core decompression combined with a non-vascularized autologous fibular graft (group A) and an allogeneic fibular graft (group B) for the treatment of ONFH.Patients and Methods We retrospectively evaluated 117 patients (153 hips) with ONFH (Association Research Circulation Osseous [ARCO] stages IIa to IIIc) who underwent the above-mentioned hip-preserving surgeries between January 2003 and June 2012. The mean (range) follow-up times (years) were 12.9 (7–16) and 9.3 (6–16) in groups A and B, respectively. Clinical outcomes were assessed using the Harris hip score (HHS), visual analog scale (VAS) score, forgotten joint score (FJS). A survival analysis was performed using the Kaplan-Meier method. The end point was THA.Results Groups A and B showed postoperative improvements, respectively, in HHS from 65±7.2 to 80.3±14.5 and from 66±5.9 to 82.4±13.6 (p<0.05), and in VAS score from 6.3±1.1 to 2.3±1.6 and from 6.1±1 to 2.2±2.2 (p<0.05). However, no significant differences in the HHS, VAS score, and hip FJS at the last follow-up (p>0.05) and 15-year survival rate (84.1% and 86%, respectively, p>0.05) were found between group A and B.Conclusions Autologous and allogeneic fibular grafts can attain equally good clinical outcomes and high survival rates in long-term follow-up, and thus can greatly delay THA owing to good bone osseointegration and sufficient mechanical support. Notably, the ratio of failure will increase when patients were more than 37 years old.Level of Evidence Level III, therapeutic study.

scholarly journals Anterolateral Necrotic Lesion Serves as an Early Warning Sign of Developing Collapse in Osteonecrosis of the Femoral Head

2021 ◽  
Author(s):  
Qiu-Shi Wei ◽  
Min-Cong He ◽  
Xiao-Ming He ◽  
Tian-Ye Lin ◽  
Peng Yang ◽  
...  
Keyword(s):  
Femoral Head ◽  
Bone Structure ◽  
Weight Bearing ◽  
Type A ◽  
Necrotic Lesion ◽  
Initial Time ◽  
Type B ◽  
Joint Preserving Surgery ◽  
Collapse Rate

Abstract Objective: Load bearing capacity of the bone structure of anterolateral weight-bearing area plays an important role in the progressive collapse in osteonecrosis of the femoral head (ONFH). The purpose of this study is to assess the efficacy of combined evaluation of anteroposterior (AP) and frog-leg lateral (FLL) view to diagnose collapse.Methods: Between December 2016 to August 2018, a total of 478 hips from 372 patients with ONFH (268 men, 104 women; mean age 37.9±11.4 years) were retrospectively evaluated. All patients received standard AP and FLL views of hip joints. Japanese Investigation Committee (JIC) classification system was used to classified necrotic lesion in AP view. Anterior necrotic lesion was evaluated by FLL view. All patients with precollapse ONFH underwent non-operative hip preserving therapy. The collapse rate was calculated and compared with Kaplan–Meier survival analysis with radiological collapse as endpoints.Results: Forty-four (44/478, 9.2%) hips were classified as type A, 65 (65/478, 13.6%) as type B, 232 (232/478, 48.5%) as type C1, and 137 (137/478, 28.7%) as type C2. Three hundred cases (300/478, 62.5%) were collapsed at the initial time point. Two hundred and twenty six (226/300, 75.3%) hips and 298 (298/300, 99.3%) hips collapse were identified with AP view and FLL view, respectively. An average follow-up of 37.0±32.0 months was conducted to evaluate the occurence of collapse in 178 precollapse hips. During follow-up period, collapse occurred in 89 hips (50.0%). Seventy-seven (77/89, 86.5%) hips was determined with AP view alone and 85 (85/89, 95.5%) hips were determined with combination of AP and FLL views. The collapse rate at five years were reported as 0% and 0%, 16.2% and 24.3%, 58.3% and 68.1%, and 100% and 100% according to combination of AP and FLL views or AP view alone for types A, B, C1, and C2, respectively.Conclusion: The collapse can be diagnosed more accurately by combination of AP and FLL views. Besides, JIC type A and type B ONFH can be treated with conservative hip preservation, but precollapse type C2 ONFH should be treated with joint-preserving surgery. Type C1 needs further study to determine which subtype has potential risk of collapse.

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