Long-term results of free vascularized fibular grafting for femoral head necrosis.

The current authors report on the long-term results of free vascularized fibula transplantation for the treatment of idiopathic femoral head necrosis. Briefly, the technique introduced by the authors in 1978 involves the excision of the necrosed bone and its replacement by autologous cancellous bone taken from the iliac crest. The contralateral fibula with its nutrient vessels is introduced through the head and neck of the femur and the vessels are anastomosed microsurgically to the anterior circumflex artery and vein. The current study assesses 60 patients (68 hips) operated on from 1978 to 1985 with an average followup of 18 years (range, 15-22 years). The overall results were good in 52% of the patients. In relation to the stage of necrosis according to the classification system of Marcus et al, good results were achieved in 80% of the patients with Stages II and III disease. In relation to patient age, good results were obtained in 80% of the patients operated on before the age of 40 years. The long-term results indicate that the method of free vascularized fibula transplantation used by the authors is a valuable method for the treatment of idiopathic osteonecrosis of the femoral head for patients younger than 40 years of age with Stage II or III necrosis.