Three Tricks for Microvascular Fibular Grafting of Osteonecrosis of the Femoral Head

In our practice we have performed microvascular fibular grafting for osteonecrosis of the femoral head since 1996. Our indications for the procedure are a symptomatic hip with grade I–II disease and age less than 50 years [3]. In patients younger than 40 years, grade III disease is also considered an indication for microvascular reconstruction. We have followed the technique described by Urbaniak in 1995 [3]. This technique was described in detail again in 2004 [1]. In our practice we have developed some modifications to the basic technique which we find to be helpful for the operation. The modifications are described in detail in this article Open image in new window Fig. 14.1. a Femoral head necrosis, grade II on the right side and grade I on the left side, in a 20-year-old woman aftermassive corticosteroid treatment. The symptomatic right hip was operated on. b Peroperative X-ray to control the removal of the necrotic bone. c Primary peroperative endoscopy through the drill hole. White necrotic bone is seen on top of the drill hole. d Endoscopic view after removing the dead bone. Bleeding bone is seen over all the defect Open image in new window Fig. 14.2. a Modified approach in the left hip. The incision is more distal and curves anteriorly in the distal end. The descending branch is easily found behind the vastus lateralis muscle. b The descending branch is cut and anastomosis is performed to the fibular vessels. The vastus intermedius is intact. c The scar after the modified approach is shorter than in the original technique (right hip)