The Effectiveness of Fibular Strut Grafting in Early Atraumatic Avascular necrosis of the Femoral Head

Kim, Ik Dong; Kim, Poong Taek; Kim, Shin Yoon; Lee, Saeng Guk

Abstract

Between 1982 and 1991, 33 cases(47 patients) with Ficat stage I and II avascular necrosis of the femoral head which had decompression with fibular strut grafting were followed up for average 62 months ranging from 36 to 136 months, The authors analyzed the results by Harris Hip Score(H.H.S) clinically and according to Ficat stage progression radiologically and evaluated the effectivencess of this procedure in the early stage of atraumatic avascular necrosis of the femoral head. The results were as follows. 29 hips were mon, 4 hips were women and 11 patients were bilateral. The ages ranged from 26 to 75 years and the mean age was 46.6 years. By the radiological classification of Japnese Investigation Committee, 23 hips(79%) of stage II showed diffuse involvement of the femoral heads(type 1-C, 2, 3-B). By Ficat stage, stage I were 4(12%) and stage II were 29(88%). At follow up, 2 hips were in stage I(6%), 15 hips were in stage II(46%), 11 hips were in stage III(33%) and 5 hips showed stage IV (15%). Two hips were converted to total hip arthroplasty due to failure. Preoperative Harris Hip Score was 84 points in average and at most recent follow up, the score was 89 points in average. The clinical surccess rate was 73% and radiological success rate was 52%, but 83% of the patients were satisfied with the procedure subjectively. There noted some disparity between the clinical and raiological results, but the effect of the decompression with fibular strut grafting will be known if more long term follow up is available.