Clinical and radiological mid-long term results of patients with osteonecrosis of the femoral head who underwent vascularized fibular grafting

Objectives: As a result of the postoperative clinical and radiological follow-ups of our patients who underwent Vascularized Fibular Grafting (VFG) surgical treatment with the diagnosis of Femoral Head Osteonecrosis (FHO); the aim of this study is to evaluate the effect of treatment efficacy and the course of the disease on the functional clinical scores before and after surgery, and to examine the necrosis of the femoral head and disease stage in relation to clinical and radiological results. Materials and Methods: VFG surgery was performed in 35 patients (32 males, 3 females) admitted to our hospital between 2012 and 2022 with the diagnosis of FHO. Radiologically, preoperative radiography and Magnetic Resonance Imaging (MRI) were staged according to Steinberg classification and Modified Kerboul (MK) angle values were measured. In addition, the area of necrosis in mm2 and the femoral head area were calculated. Harris Hip Score (HHS) and Visual Analogue Scale (VAS) values were documented as preoperative and postoperative clinical scoring of the patients. Postoperative, monthly x-rays were taken for the first 6 months, and then evaluation was made every 3 months. Also, the integration time between graft and recipient site was calculated in Computed Tomography (CT), which was taken 3 months in the first year. In addition, the presence of preoperative and postoperative collapse in the patients and the amount in mm were calculated by means of x-rays. Of our patients with a mean age of 36.6 (range 21-52) and followed for an average of 4.1 years; 22 (63%) were Stage IV, 6 (17%) were Stage III and 7 (20%) were Stage II. Mostly advanced stage and large necrosis patient groups were included in the study. Results: While the median value of preoperative HHS (minimum-maximum) was 29 (13-75), postoperative HHS was 91 (46-100) were observed. Preoperative mean MK angle was 289.3o (Grade 3) and the mean necrosis rate was 51.3%. While 37% of our patients were in the precollapse stage preoperatively, 63% of them were in the postcollapse stage; it was observed that the median HHS values of the patients in the precollapse stage increased from 31 to 92. In addition, it was observed that the median HHS values of 22 patients with Stage IV, increased from 27 to 80.5 and a statistically significant relationship was found (p=0.027). It was observed that the mean postoperative HHS value of 18 patients who were Grade 4 according to the MK classification was 82. Conclusion: VFG surgery can be performed in postcollapse patients as well as precollapsed patients, its results are satisfactory and it is argued that it minimizes the need for arthroplasty. In addition, it is argued that functional clinical results are good in patients with large necrosis and that the need for arthroplasy is postponed to the next decades, thereby increasing biological hip survival. Key Words: Femoral head osteonecrosis, vascularized fibular grafting, avascular necrosis, joint sparing surgery, large lesion, advanced stage.