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Surgical Technique: Free Vascularized Fibular Graft for AVN

Hip Arthroscopy and Hip Joint Preservation Surgery

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Abstract

Avascular necrosis (AVN) or osteonecrosis of the femoral head (ONFH) is a common cause of hip pain and disability in a young patient demographic with an average age of mid-30s. If left untreated, approximately 80 % of cases of ONFH will result in femoral head collapse and hip degeneration necessitating total hip arthroplasty (THA) in a mean of 2 years. The relatively poor outcomes and requisite lifestyle changes associated with THA in this patient population have challenged surgeons to seek alternative treatment options. Vascularized bone grafts have been shown to have better radiographical and clinical results compared to nonvascularized bone grafts. Of these options, free vascularized fibular graft (FVFG) is the treatment of choice for its structural and vascular support within the femoral head. Improved technique has led to complication rates, including donor-site morbidity, statistically similar to that of nonvascular fibular grafts. When used in young patients with precollapse ONFH, FVFG can greatly improve patient outcome, with lower rates of conversion to THA than other treatment modalities.

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Authors and Affiliations

  1. Orthopaedic Surgery, Duke University School of Medicine, DUMC 2887, Durham, NC, 27710, USA

    Richard C. Mather III

  2. Rush Medical School, Chicago, IL, USA

    Andrew E. Federer

  3. Duke University Health System, Durham, USA

    David S. Ruch

Authors
  1. Richard C. Mather III
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  2. Andrew E. Federer
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  3. David S. Ruch
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Corresponding author

Correspondence to Richard C. Mather III .

Editor information

Editors and Affiliations

  1. Dept. of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA

    Shane Nho

  2. Dept. Orthopaedics, Hip Service, Schulthess Clinic, Zurich, Switzerland

    Michael Leunig

  3. Caspary Building, Ground Floor, Center for Hip Pain and Preservation, New York, New York, USA

    Bryan Kelly

  4. Department of Orthopaedics, University of Michigan Domino's Farms Lobby A, Ann Arbor, Michigan, USA

    Asheesh Bedi

  5. Twin Cities Orthopedics - Edina, Edina, Minnesota, USA

    Christopher Larson

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Mather, R.C., Federer, A.E., Ruch, D.S. (2014). Surgical Technique: Free Vascularized Fibular Graft for AVN. In: Nho, S., Leunig, M., Kelly, B., Bedi, A., Larson, C. (eds) Hip Arthroscopy and Hip Joint Preservation Surgery. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-7321-3_94-1

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  • DOI: https://doi.org/10.1007/978-1-4614-7321-3_94-1

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  • Publisher Name: Springer, New York, NY

  • Online ISBN: 978-1-4614-7321-3

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Chapter history

  1. Latest

    Surgical Technique: Free Vascularized Fibular Graft for Avascular Necrosis
    Published:
    12 February 2022

    DOI: https://doi.org/10.1007/978-1-4614-7321-3_94-2

  2. Original

    Surgical Technique: Free Vascularized Fibular Graft for AVN
    Published:
    07 June 2014

    DOI: https://doi.org/10.1007/978-1-4614-7321-3_94-1

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