Mid- to long-term results of modified avascular fibular grafting for ONFH

Free vascularized fibular grafting was reported a favorable method to prevent the collapse of the femoral head. This study analyzed the mid- to long-term outcomes of avascular fibular grafting (AVFG) for osteonecrosis of the femoral head (ONFH) with 6- to 8-year follow-up. From March 2009 to March 2012, 34 patients (48 hips) were diagnosed with ONFH operated with AVFG in Jiangsu Province Hospital of traditional Chinese Medicine. We retrospectively reviewed the clinic outcomes of these patients and evaluated the differences in outcomes by diverse stages [Association Research Circulation Osseous (ARCO)] and types [China-Japan Friendship Hospital (CJFH) classification] annually. The hip survival rate, Harris hip score (HHS), activity level and imaging stability were calculated. The average follow-up time was 6.7 years. At the last follow-up, 34 of 48 hips survived totally. According to the ARCO stage, the overall clinical success rate for hip preserving were 76.0% (19/25) in II stage, 85.7% (12/14) in IIIA stage and 33.3% (3/9) in IIIB stage. Referring to the CJFH classification system, the hip survival rate were 100% (2/2) in M type, 90.9% (10/11) in C type, 77.8% (14/18) in L1 type, 57.1% (8/14) in L2 type and 0% (0/3) in L3 type. The mean visual analog scale (VAS) score, HHS and Western Ontario McMaster Osteoarthritis index (WOMAC) were significantly improved at the final follow-up compared with pre-operative values (P < 0.001). The AVFG operation can increase the hip function and improve patients' lives quality. The mid- to long-term efficacy can satisfy fundamental life requirements, especially for those early-stage and small-scale patients who suffer ONFH to avoid or put off the time of total hip arthroplasty surgery.