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Surgical Technique: Free Vascularized Fibular Graft for Avascular Necrosis

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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 affecting 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) at 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 demonstrated 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.

Illustrations by Brittney Ciszek, DDS, PhD.

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Author information

Authors and Affiliations

  1. Department of Orthopaedics, Duke University Medical Center, Durham, NC, USA

    David S. Ruch

  2. Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA

    Dillon C. O’Neill

  3. Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA

    Richard C. Mather III

  4. Department of Orthopedics, University of Utah Health Care, Salt Lake City, UT, USA

    Andrew E. Federer

  5. Rush Medical School, Chicago, IL, USA

    Andrew E. Federer

Authors
  1. Richard C. Mather III
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  2. Dillon C. O’Neill
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  3. Andrew E. Federer
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  4. David S. Ruch
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Corresponding author

Correspondence to Dillon C. O’Neill .

Editor information

Editors and Affiliations

  1. Department of Orthopaedic Surgery, Division of Sports Medicine, Section of Young Adult Hip Surgery, Rush University Medical Center, Chicago, IL, USA

    Shane J. Nho

  2. Sports Medicine and Shoulder Service, Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA

    Asheesh Bedi

  3. Department of Orthopaedic Surgery, Joint Preservation and Cartilage Restoration Center, University Hospitals Case Medical Center, Cleveland, OH, USA

    Michael J. Salata

  4. Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA

    Richard C. Mather III

  5. Department of Orthopaedic Surgery, Sports Medicine and Shoulder Service, Center for Hip Preservation Surgery Weill Medical College of Cornell University, Hospital for Special Surgery, New York, NY, USA

    Bryan T. Kelly

Section Editor information

  1. Department of Orthopedic Surgery, Henry Ford Health System and School of Medicine, Wayne State University, Detroit, MI, USA

    Eric C. Makhni

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Mather, R.C., O’Neill, D.C., Federer, A.E., Ruch, D.S. (2022). Surgical Technique: Free Vascularized Fibular Graft for Avascular Necrosis. In: Nho, S.J., Bedi, A., Salata, M.J., Mather III, R.C., Kelly, B.T. (eds) Hip Arthroscopy and Hip Joint Preservation Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-43240-9_94

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  • DOI: https://doi.org/10.1007/978-3-030-43240-9_94

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-43239-3

  • Online ISBN: 978-3-030-43240-9

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