Limitations of Joint-Preserving Treatment for Osteonecrosis of the Femoral Head: Limitation of Free Vascularized Fibular Grafting

Fifty-six hips of 46 patients undergoing free vascularized fibular grafting for the treatment of osteonecrosis of the femoral head were investigated. The average age at surgery was 39 years, and the average follow-up period was 6 years. Associated etiological factors included a history of high-dose steroids for 27 hips, consumption of alcohol for 25, and idiopathy for 4 hips. The radiographic appearance, determined according to the staging system of the Japanese Investigation Committee, was stage 1 for 2 hips, stage 2 for 28, stage 3A for 15, stage 3B for 10, and stage 4 for 1 hip. The radiographic type of necrosis, determined according to the radiographic classification of the Japanese Investigation Committee, was type B for 4 hips, type C-1 for 20, and type C-2 for 32 hips. The clinical results of steroid-induced osteonecrosis were poorest among the etiologies. Twenty-four hips collapsed or progressed radiographically. There was a significant relationship between preoperative stage and radiographic progression. There was also a significant relationship between preoperative type and radiographic progression. Eleven hips were converted to total hip arthroplasty. In conclusion, the current results show that vascularised fibular grafting is a good procedure for the precollapse stages and a valuable alternative for patients with stage 3A.