Free vascularized fibular grafting for treatment of osteonecrosis of the femoral head secondary to hip dislocation

Abstract Traumatic dislocation of the hip results in osteonecrosis of the femoral head (ONFH) or avascular necrosis (AVN) in ∼40% of patients. This high‐energy event causes an ischemic insult to the femoral head that may lead to ONFH. Here, we investigate use of Free‐Vascularized Fibular Grafting (FVFG) in patients with ONFH after traumatic hip dislocation. Thirty‐five patients with FVFG for this indication were reviewed (average follow‐up 3.3 years, range 1–21). We reviewed patient injury statistics, demographics, preoperative radiographs, pre‐ and postoperative Harris Hip scores, complications, and rate of conversion to total hip arthroplasty (THA). The majority (81%) of our patients were young males (22 years) with ONFH diagnosed an average of 2 years after injury. The average preoperative Harris Hip score was 64.9 which improved by over 10 points to 76.1 at 1‐year follow‐up. Seven of 35 patients required conversion to THA at an average of 45 (13–86) months postoperation. After a maximum follow up of 21 years, the remainder of the patients retained their native hips and Harris Hip scores tended to show improved hip function. © 2009 Wiley‐Liss, Inc. Microsurgery, 2009.