Article
Free vascularized fibular grafting improves the vascularity of osteonecrosis of the femoral head: A randomized, self-controlled clinical trial
Search Medline for
Authors
-
Lu Cao
- Department of Orthopedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
-
Changan Guo
- Department of Orthopedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
-
Jifei Chen
- Department of Orthopedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
-
Jing Zhang
- Department of Orthopedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
-
Bingxuan Hua
- Department of Orthopedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
-
Chen Li
- Department of Orthopedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
-
Zenggan Chen
- Department of Orthopedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
-
Zuoqin Yan
- Department of Orthopedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| Published: | October 23, 2017 |
|---|
Outline
Text
Objectives: The management of osteonecrosis of the femoral head (ONFH) remains a challenge. Core decompression (CD) and free vascularized fibular grafting (FVFG) are widely used surgical procedures for the treatment of ONFH. The objectives of this study was to compare the outcomes of these two procedures in terms of improved vascularity of the femoral head and relationship between the change in vascularity of the femoral head and hip function?
Methods: A randomized controlled trial was performed between June 2010 and October 2012 at XXX, XXX Hospital. During the study period, 51 patients who presented with bilateral ONFH were potentially eligible for inclusion, and 33 patients were identified as meeting the inclusion criteria and offered enrollment and randomization. Six patients declined to participate at the time of randomization, leaving a final sample of 27 participants (54 hips). The two hips of each patient were randomly assigned to surgical options: one side was treated with CD, and the contralateral side was concurrently treated with FVFG. All patients were assessed clinically before treatment and followed up at 6, 12, 18, 24, 30 and 36 months after treatment, based on the Harris hip score (HHS). Hips were graded according to the Association Research Circulation Osseous (ARCO) classification. Single photon emission computerized tomography and computerized tomography (SPECT/CT) examinations were performed to evaluate the vascularity of the femoral head before treatment and 6 and 36 months after the operation. Patient progression to total hip arthroplasty (THA) was defined as the endpoint for follow-up. Six patients were lost to follow-up.
Results and Conclusion: Although the mean HHS was significantly improved from 60.81 ± 7.5 to 67.29 ± 6 and 70.76 ± 5.7 in the CD group at 6 and 12 months post-intervention, respectively (p < 0.05), these scores were significantly lower than those in the FVFG group over the entire postoperative period (p <0.05). MRI analysis showed significant worsening in the CD group (p < 0.05). By SPECT/CT analysis, CD-treated hips showed slight improvement in the vascularity status of the femoral head after surgery, but there was no significant difference compared with the baseline value (p = 0.14), and the vascularity decreased at 36 months (p < 0.05). FVFG-treated hips showed significant improvement (nearly 50%) in the vascularity of the femoral head after surgery (p < 0.05), which was maintained for 3 years post-surgery.
Hips that underwent an FVFG procedure showed a significantly better clinical outcome than hips receiving CD. The long-term satisfactory outcomes associated with FVFG treatment stem largely from improvements in vascularity and the potential for bone revitalization.
