Free Vascularized Proximal Fibular Epiphyseal Transfer For Hip Reconstruction Following Septic Necrosis In Children

Area of Science:

• Orthopedic Surgery
• Pediatric Orthopedics
• Reconstructive Surgery

Background:

• Septic necrosis of the femoral head and neck in children poses significant reconstructive challenges.
• Existing reconstructive techniques often yield disappointing long-term results.
• Vascularized epiphyseal transfer, primarily used for other joints, is explored for hip reconstruction.

Purpose of the Study:

• To evaluate the efficacy of vascularized epiphyseal transfer for hip reconstruction in children with septic necrosis of the femoral head and neck.
• To report the largest series of this specific reconstructive technique for pediatric hip preservation.

Main Methods:

• A cohort of 18 pediatric patients (average age 5.4 years) underwent vascularized epiphyseal transfer.
• Average follow-up duration was 3.6 years.
• Level IV evidence study.

Main Results:

• Successful transfers showed longitudinal growth averaging 7.3 mm/year, with faster growth during puberty.
• Ten patients experienced limb length discrepancy (average 2.8 cm).
• Thirteen patients achieved satisfactory functional outcomes, while three had unsatisfactory results, often linked to poor neck-shaft angle.

Conclusions:

• Vascularized epiphyseal transfer is a promising treatment for pediatric hip reconstruction following septic necrosis when other methods fail.
• Optimal results are recommended when the procedure is performed before the age of five.
• Open growth plates at final follow-up correlated with successful transfers.