A Mid- to Long-Term Results of The Avascular Fibular Grafting in ONFH With 6 to 8-Year Follow-Up

Abstract Background: Free vascularized fibular grafting was reported a favorable method to prevent the collapse of the femoral head. Nevertheless, this operation is traumatic and expensive. This study analyzed the long-term outcomes of avascular fibular grafting for osteonecrosis of the femoral head(ONFH) with 6 to 8 year follow-up.Methods: From March 2009 to March 2012, 34 patients(48 hips) were diagnosed the ONFH with Association Research Circulation Osseous(ARCO) stage of Ⅱ to Ⅲb and operated with avascular fibular grafting in Jiangsu Province Hospital of traditional Chinese Medicine. We retrospectively reviewed the clinic effects of these patients and assessed the difference effects with diverse stages(ARCO) and types(China-Japan Friendship Hospital classification, CJFH) annually. The hip survival rate, Harris hip score, activity level and imaging stability were calculated. The average follow-up time was 6.7 years.Results: At the last follow-up,34 of 48 hips survived totally. Depending on the ARCO stage, The overall clinical success rate for hip preserving were 76.0% (19/25) in Ⅱ stage ,85.7%(12/14) in ⅢA stage and 33.3%(3/9) in ⅢB stage. Referring to the CJFH classification system, the hip survival rate were 100%(2/2) in M type,90.9%(10/11) in C type,77.8%(14/18) in L1 type,57.1%(8/14) in L2 type and 0%(0/3) in L3 type. The mean VAS score, HHS, and WOMAC were significantly improved at the final follow-up compared with preoperative values (p < 0.001).Conclusion: The avascular fibular grafting operation can increase the hip function and improve patients’ lives quality. It possesses vast clinical as well as practical significance, because the long-term efficacy can satisfy fundamental life requirements, especially for those early-stage and small-scale patients who suffer ONFH to avoid or put off the time of total hip arthroplasty(THA) surgery.