Cesar G Fontecha1, Isabel Roca2, Ignasi Barber3, Mariano E Menendez4, Diego Collado5, Vasco V Mascarenhas6, Sergio Barrera-Ochoa7, Francisco Soldado8. 1. Pediatric Orthopaedic Unit, Hospital Universitari Vall D'hebron, Barcelona, Spain. 2. Nuclear Medicine Department, Hospital Universitari Vall D'hebron, Barcelona, Spain. 3. Pediatric Radiology Department, Hospital Universitari Vall D'hebron, Barcelona, Spain. 4. Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA. 5. Hip Surgery Unit, Hospital Universitari Vall D'hebron, Barcelona, Spain. 6. Radiology Department, UIME, Hospital Da Luz, Lisboa, Portugal. 7. Hand Surgery, Hospital Universitari Vall D'hebron, Barcelona, Spain. 8. Pediatric Hand Surgery and Microsurgery, Hospital Sant Joan De Deu. Universitat De Barcelona, Spain. drsoldado@cirugiamanoinfantil.com.
Abstract
PURPOSE: To evaluate femoral head bone viability following free vascularized fibular grafting (FVFG) for osteonecrosis using SPECT/CT imaging. METHODS: Ten hips (9 patients) with osteonecrosis of the femoral head (ONFH) undergoing FVFG were prospectively enrolled. Four cases showed ARCO stage II, while six showed ARCO stage III. The mean age at surgery was 15.7 years (range, 13-22 years). Hip Harris Score (HHS) was measured pre- and post-operative. Bone scintigraphy with SPECT/CT was performed at 2 weeks and 6 months following surgery. RESULTS: Mean follow-up was 4.0 years (range, 2-5.9 years). Mean HHS increased from 37.2 to 92.3. SPECT/CT findings revealed a progressive increase of femoral head uptake in all cases, suggesting subchondral graft bone viability. No progressive deformation of the femoral head was evidenced in radiographic evaluation at final follow-up. CONCLUSIONS: This study demonstrates FVFG's capacity for revitalizing femoral head subchondral bone grafting in patients with ONFH, surgically treated following Urbaniak's technique.
PURPOSE: To evaluate femoral head bone viability following free vascularized fibular grafting (FVFG) for osteonecrosis using SPECT/CT imaging. METHODS: Ten hips (9 patients) with osteonecrosis of the femoral head (ONFH) undergoing FVFG were prospectively enrolled. Four cases showed ARCO stage II, while six showed ARCO stage III. The mean age at surgery was 15.7 years (range, 13-22 years). Hip Harris Score (HHS) was measured pre- and post-operative. Bone scintigraphy with SPECT/CT was performed at 2 weeks and 6 months following surgery. RESULTS: Mean follow-up was 4.0 years (range, 2-5.9 years). Mean HHS increased from 37.2 to 92.3. SPECT/CT findings revealed a progressive increase of femoral head uptake in all cases, suggesting subchondral graft bone viability. No progressive deformation of the femoral head was evidenced in radiographic evaluation at final follow-up. CONCLUSIONS: This study demonstrates FVFG's capacity for revitalizing femoral head subchondral bone grafting in patients with ONFH, surgically treated following Urbaniak's technique.