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Title: Long-Term Results in the Treatment of Avascular Necrosis of Femoral Head with Free Vascularized Fibular Graft
Authors: Noshi Bibi, Mamoon Rashid, Sohail Hafeez, Saad ur Rehman, Haroon ur Rashid, Sakina Malik
Journal: Pakistan Armed Forces Medical Journal (PAFMJ)
Publisher: Army Medical College, Rawalpindi.
Country: Pakistan
Year: 2023
Volume: 73
Issue: 6
Language: English
Keywords: Avascular femoral head necrosisHarris hip scores and vascularized fibular graft
Objective: to evaluate outcomes of vascularized fibula flap used for Avascular necrosis of femoral head. Outcomes were recorded by post-operative Harris hip and radiological improvement of the femoral head.
Study Design: Retrospective longitudinal study.
Place and Duration of Study: Department of Plastic Surgery, Shifa International Hospital, Islamabad Pakistan, from Jan 2019 to Jan 2020.
Methodology: Cases were recruited from 2005-2018 (SIH) performed by the same Orthopaedic and Plastic Surgeon. Data from 30 patients was reviewed. Ethical approval and consent of the patient were taken before the utilization of their data.
Results: A total of 30 patients were included, comprising 27(90%) males and 3(10%) females. The mean age was 28.3± years. Pre-operative Harris Hip scores were fair in 17(56.7%) and poor in 13(43.3%) patients. Post operatively these scores improvedv and were noted to be excellent in 10(33.3%), good in 18(60%) and fair in 2(6,7%) patients. Radiological improvement was seen in 20(80%) patients, 8(23.3%) showed no change and 2(6.7%) went into progression. The radiological improvement was significantly associated with aetiology (p=0.004) and Avascular necrosis of HIP (p=0.007).
Conclusion: A vascularized fibular graft is an effective treatment option for avascular necrosis of the femoral head in terms of improved radiological outcomes and post-operative Harris Hip scores.
To evaluate the outcomes of using a vascularized fibula flap for avascular necrosis of the femoral head, assessing post-operative Harris hip scores and radiological improvement.
Retrospective longitudinal study involving the review of data from 30 patients treated between 2005 and 2018. Patients aged >16-40 years, diagnosed with femoral head avascular necrosis (Steinberg Classification I-III), and treated with free vascularized fibular graft were included. Exclusion criteria included previous hip replacement surgeries, collapsed joints, severe steroid dependency, and serious co-morbidities. Data collected included age, gender, aetiology, post-operative Harris Hip scores, and radiological improvement. Statistical analysis was performed using SPSS version 24.0.
graph TD
A["Recruit 30 patients 2005-2018"] --> B["Collect patient data: age, gender, aetiology, pre/post-op Harris Hip scores, radiological outcomes"];
B --> C["Ethical approval and patient consent obtained"];
C --> D["Perform statistical analysis using SPSS v24.0"];
D --> E["Analyze results for Harris Hip scores and radiological improvement"];
E --> F["Identify associations between variables and outcomes"];
F --> G["Formulate conclusions and discussion"];
The study suggests that free vascularized fibular grafting is an effective joint-preserving procedure for pre-collapse stage avascular necrosis of the femoral head, improving pain and delaying the need for hip joint replacement. Idiopathic and post-traumatic aetiologies showed more radiological improvement. Conversion to total hip replacement occurred in 16.7% of patients after 10 years and 6.7% between 5-10 years.
A total of 30 patients (90% males, 10% females) with a mean age of 28.3 years were included. Pre-operative Harris Hip scores were fair in 56.7% and poor in 43.3%. Post-operatively, scores improved to excellent in 33.3%, good in 60%, and fair in 6.7%. Radiological improvement was observed in 80% of patients, with 23.3% showing no change and 6.7% showing progression. Radiological improvement was significantly associated with aetiology (p=0.004) and unilateral hip involvement (p=0.007).
A vascularized fibular graft is an effective treatment option for avascular necrosis of the femoral head, leading to improved radiological outcomes and post-operative Harris Hip scores, particularly in younger patients with pre-collapse disease.
1. Patient Demographics: The study included 30 patients, with 27 (90%) males and 3 (10%) females.
2. Post-operative Harris Hip Scores: Post-operative scores improved to excellent in 10 (33.3%) patients, good in 18 (60%), and fair in 2 (6.7%).
3. Radiological Improvement: Radiological improvement was seen in 20 (80%) patients.
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