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Archives of Orthopaedic and Trauma Surgery

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01-01-2013 | Orthopaedic Surgery

Vascularized fibular grafts in patients with avascular necrosis of femoral head: a systematic review and meta-analysis

Authors: Taolin Fang, Elizabeth W. Zhang, Frederick C. Sailes, Robert A. McGuire, William C. Lineaweaver, Feng Zhang

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 1/2013

Abstract

Background

Vascularized fibular grafting (VFG) has been initiated to treat avascular necrosis of the femoral head (ANFH) since the late 1970s. There are a number of review articles updating the use of VFG to treat the ANFH. None of them applied statistical analysis for combining results from different studies to obtain a quantitative estimate of the overall effect and potential harm of VFG in comparison to other treatment.

Methods

Several electronic databases were searched to find studies using VFG to treat ANFH. The outcomes sought included Harris Score, failure rate (conversion to total hip arthroplasty (THA) and/or femoral head collapse), and complications rate. Included studies were assessed for methodological bias and estimates of effect were calculated. Potential reasons for heterogeneity were explored.

Results

The clinical results of 69.0 % of VFG-treated patients and 25.0 % of non-VFG-treated patients were good to excellent (OR 0.13; p < 0.01). The conversion rate to THA of VFG-treated and that of other methods treated hips was 16.5 % and 42.6 % (OR 0.19; p < 0.001). Collapse rate of VFG-treated and that of non-VFG-treated hips was 16.7 % and 63.6 % (OR 0.09; p < 0.05). The complication rate of VFG-treated and that of other methods treated patients was 23.8 % and 8.9 % (OR 3.44; p = 0.09). For Steinberg stage I, II ANFH, failure rate of VFG-treated and that of non-VFG-treated hips was 9.8 % and 40.2 % (OR 0.17; p < 0.001). For Steinberg stage II, III ANFH, failure rate of VFG-treated and that of non-VFG-treated hips was 16.5 % and 42.8 %, respectively (OR 0.17; p < 0.001).

Conclusions

VFG is a justified method that can prevent the ANFH from progressing to collapse, and that can retard or avoid hip replacement, especially in the hips of Steinberg stage I, II, and III.

Mankin HJ (1992) Nontraumatic necrosis of bone (osteonecrosis). N Engl J Med 326(22):1473–1479PubMedCrossRef

Ohzono K, Saito M, Takaoka K (1991) Natural history of nontraumatic avascular necrosis of the femoral head. J Bone Joint Surg Br 73(1):68–72PubMed

Roshan A, Ram S (2008) The neglected femoral neck fracture in young adults: review of a challenging problem. Clin Med Res 6(1):33–39PubMedCrossRef

Arlet J (1992) Nontraumatic avascular necrosis of the femoral head. Past, present, and future. Clin Orthop Relat Res 277:12–21PubMed

Aldridge JM 3rd, Urbaniak JR (2007) Avascular necrosis of the femoral head: role of vascularized bone grafts. Orthop Clin North Am 38(1):13–22PubMedCrossRef

Fairbank A, Bhatia D, Jinnah R, Hungerford D (1995) Long-term results of core decompression for ischaemic necrosis of the femoral head. J Bone Joint Surg Br 77:42–49PubMed

Koo K, Kim R, Ko G, Song H, Jeong S, Cho S (1995) Preventing collapse in early osteonecrosis of the femoral head. A randomised clinical trial of core decompression. J Bone Joint Surg Br 77:870–874PubMed

Mont M, Carbone J, Fairbank A (1996) Core decompression versus nonoperative management for osteonecrosis of the hip. Clin Orthop 324:169–178PubMedCrossRef

Helbig L, Simank HG, Kroeber M, Schmidmaier G, Grutzner PA, Guehring T (2012) Core decompression combined with implantation of a demineralised bone matrix for non-traumatic osteonecrosis of the femoral head. Arch Orthop Trauma Surg 132(8):1095–1103PubMedCrossRef

10.

Aaron R, Lennox D, Bunce G, Ebert T (1989) The conservative treatment of os- teonecrosis of the femoral head. A comparison of core decompression and pulsing electromagnetic fields. Clin Orthop 249:209–218PubMed

11.

Bassett C, Schink-Ascani M, Lewis S (1989) Effects of pulsed electromagnetic fields on Steinberg ratings of femoral head osteonecrosis. Clin Orthop 246:172–185PubMed

12.

Sugioka Y, Hotokebuchi T, Tsutsui H (1992) Transtrochanteric anterior rotational osteotomy for idiopathic and steroid-induced necrosis of the femoral head. Indications and long-term results. Clin Orthop Relat Res 227:111–120

13.

Boettcher W, Bonfiglio M, Smith K (1970) Non-traumatic necrosis of the femoral head. II. Experiences in treatment. J Bone Joint Surg Am 52:322–329PubMed

14.

Buckley P, Gearen P, Petty R (1991) Structural bone-grafting for early atraumatic avascular necrosis of the femoral head. J Bone Joint Surg Am 73:1357–1364PubMed

15.

Smith K, Bonfiglio M, Montgomery WJ (1980) Non-traumatic necrosis of the femo- ral head treated with tibial bone-grafting. A follow-up note. J Bone Joint Surg Am 62:845–847PubMed

16.

Katz R, Bourne R, Rorabeck C, McGee H (1992) Total hip arthroplasty in patients with avascular necrosis of the hip. Follow-up observations on cementless and cemented operations. Clin Orthop 281:145–151PubMed

17.

Kirschenbaum I, Vernace J, Booth RJ, Balderston R, Rothman R (1991) Total hip arthroplasty for osteonecrosis. Semin Arthroplasty 2:234–240PubMed

18.

Gonzalez Della Valle A, Bates J, Di Carlo E, Salvati EA (2005) Failure of free vascularized fibular graft for osteonecrosis of the femoral head: a histopathologic study of 6 cases. J Arthroplasty 20(3):331–336PubMedCrossRef

19.

Plakseychuk AY, Kim SY, Park BC, Varitimidis SE, Rubash HE, Sotereanos DG (2003) Vascularized compared with nonvascularized fibular grafting for the treatment of osteonecrosis of the femoral head. J Bone Joint Surg Am 85:589–596PubMed

20.

Scully SP, Aaron RK, Urbaniak JR (1998) Survival analysis of hips treated with core decompression or vascularized fibular grafting because of avascular necrosis. J Bone Joint Surg Am 80(9):1270–1275PubMed

21.

Gilbert A, Judet H, Judet J, Ayatti A (1986) Microvascular transfer of the fibula for necrosis of the femoral head. Orthopedics 9:885–890PubMed

22.

Urbaniak J, Coogan P, Gunneson E, Nunley J (1995) Treatment of osteonecrosis of the femoral head with free vascularized fibular grafting. A long-term follow-up study of one hundred and three hips. J Bone Joint Surg Am 77:681–694PubMed

23.

Sotereanos D, AY P, Rubash H (1997) Free vascularized fibula graft-ing for the treatment of osteonecrosis of the femoral head. Clin Orthop Relat Res 344:243–256PubMedCrossRef

24.

Steinberg ME, Larcom PG, Strafford B, Hosick WB, Corces A, Bands RE, Hartman KE (2001) Core decompression with bone grafting for osteonecrosis of the femoral head. Clin Orthop Relat Res 386:71–78PubMedCrossRef

25.

Hungerford DS (2007) Treatment of osteonecrosis of the femoral head: everything’s new. J Arthroplasty 22(4 Suppl 1):91–94PubMedCrossRef

26.

Aulakh TS, Rao C, Kuiper JH, Richardson JB (2010) Hip resurfacing and osteonecrosis: results from an independent hip resurfacing register. Arch Orthop Trauma Surg 130(7):841–845PubMedCrossRef

27.

Chen W, Zhang F, Chang S-M, Hui K, Lineaweaver WC (2006) Microsurgical fibular flap for treatment of avascular necrosis of the femoral head. J Am Coll Surg 202(2):324–334PubMedCrossRef

28.

Korompilias AV, Beris AE, Lykissas MG, Kostas-Agnantis IP, Soucacos PN (2011) Femoral head osteonecrosis: why choose free vascularized fibula grafting. Microsurgery 31(3):223–228PubMedCrossRef

29.

Zhang CQ, Gao YS, Zhu ZH, Yu XW (2011) Why we choose free vascularized fibular grafting for osteonecrosis of the femoral head? Microsurgery 31(5):417–418PubMedCrossRef

30.

Tetik C, Basar H, Bezer M, Erol B, Agir I, Esemenli T (2011) Comparison of early results of vascularized and non-vascularized fibular grafting in the treatment of osteonecrosis of the femoral head. Acta Orthop Traumatol Turc 45(5):326–334PubMed

31.

Kane SM, Ward WA, Jordan LC, Guilford WB, Hanley EN Jr (1996) Vascularized fibular grafting compared with core decompression in the treatment of femoral head osteonecrosis. Orthopedics 19(10):869–872PubMed

32.

Plakseychuk AY, Shah M, Varitimidis SE, Rubash HE, Sotereanos D (2001) Classification of osteonecrosis of the femoral head. Reliability, reproducibility, and prognostic value. Clin Orthop Relat Res 386:34–41PubMedCrossRef

33.

(2011) Cochrane handbook for systematic reviews of interventions, version 5.1.0 The Cochrane Collaboration, London, Available from: http://www.cochrane-handbook.org/

34.

(2010) The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses Ottawa. Ottawa Hospital Research Institute, http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp

35.

Borenstein M, Hedges LV, Higgins JPT, Rothstein HR (2009) Introduction to meta-analysis. Wiley, ChichesterCrossRef

36.

DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7:177–188PubMedCrossRef

37.

(2011) Review Manager (RevMan), Version 5.1. The Nortic Cochrane Centre, The Cochrane Collabration, Copenhagen

38.

Kim SY, Kim YG, Kim PT, Ihn JC, Cho BC, Koo KH (2005) Vascularized compared with nonvascularized fibular grafts for large osteonecrotic lesions of the femoral head. J Bone Joint Surg Am 87(9):2012–2018PubMedCrossRef

39.

Yen CY, Tu YK, Ma CH, Yu SW, Kao FC, Lee MS (2006) Osteonecrosis of the femoral head: comparison of clinical results for vascularized iliac and fibula bone grafting. J Reconstr Microsurg 22(1):21–24PubMedCrossRef

40.

Harris W (1969) Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am 51:737–755PubMed

41.

Brannon JK (2007) Influence of acetabular coverage on hip survival after free vascularized fibular grafting for femoral head osteonecrosis. J Bone Joint Surg Am. 89(2):448–449 author reply 449–450PubMed

42.

Katz MA, Urbaniak JR (2001) Free vascularized fibular grafting of the femoral head for the treatment of osteonecrosis. Tech Orthop 16(1):44060CrossRef

43.

Kaushik AP, Das A, Cui Q (2012) Osteonecrosis of the femoral head: An update in year. World J Orthop 3(5):49–57PubMedCrossRef

44.

Ficat P, Arlet J (1977) Etiopathogenesis of arthrosis; nosological consequences. Rev Rhum Mal Osteoartic 44(11):627–631PubMed

45.

Steinberg ME, Hayken GD, Steinberg DR (1995) A quantitative system for staging avascular necrosis. J Bone Joint Surg Br 77(1):34–41PubMed

Title: Vascularized fibular grafts in patients with avascular necrosis of femoral head: a systematic review and meta-analysis
Authors: Taolin Fang
Elizabeth W. Zhang
Frederick C. Sailes
Robert A. McGuire
William C. Lineaweaver
Feng Zhang
Publication date: 01-01-2013
Publisher: Springer-Verlag
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 1/2013
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-012-1627-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Vascularized fibular grafts in patients with avascular necrosis of femoral head: a systematic review and meta-analysis

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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