Vascularized fibular grafting for treatment of aseptic necrosis of the femoral head--preliminary results in four cases.

Vascularized grafting with segments of fibula was performed in four men with aseptic necrosis of the femoral head. The patients were restricted to relatively young individuals in whom the necrosis seemed to be confined to two-thirds or less of the femoral head and in whom the outer shell of the femoral head appeared relatively well preserved. The operative technique is described, and the interim results from follow-up ranging from one year, two months to three years, eight months are reported. Three of the four hips became asymptomatic after surgery with x-ray films showing no progression of the necrosis or deformity. In one hip, however, mild pain, bony absorption, and some progression of the deformity persisted. Although the final results in these four cases remain to be seen, vascularized fibular grafting will find a place in the treatment of early avascular necrosis of the femoral head.