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Journal of Bone and Joint Surgery - British Volume, Vol 91-B, Issue 3, 287-293.
doi: 10.1302/0301-620X.91B3.21846  
Copyright © 2009 by British Editorial Society of Bone and Joint Surgery
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Vascularised fibular graft in the management of femoral head osteonecrosis

TWENTY YEARS LATER

A. V. Korompilias, MD, Orthopaedic Surgeon, Assistant Professor1; M. G. Lykissas, MD, Orthopaedic Surgeon, Resident1; A. E. Beris, MD, Orthopaedic Surgeon, Professor1; J. R. Urbaniak, MD, Orthopaedic Surgeon, Professor2; and P. N. Soucacos, MD, FACS, Orthopaedic Surgeon, Professor3

1 Department of Orthopaedic, Surgery, School of Medicine, University of Ioannina, Panepistimioupoli Street, Ioannina, P. C. 45110 Greece.
2 Division of Orthopaedic Surgeon, Duke University Medical Center, 2912-3116 N. Duke Street, Durham, North Carolina, 27704, USA.
3 Department of Orthopaedic Surgery, School of Medicine, University of Athens, 13 Sofokleous Street, Polita, P. C. 14671 Athens, Greece.

Correspondence should be sent to Dr A. V. Korompilias; e-mail: koroban{at}otenet.gr

The management of osteonecrosis of the femoral head ranges from symptomatic therapy to total hip replacement. Conservative treatment is effective only in small, early-stage lesions. Free vascularised fibular grafting has provided more consistently successful results than any other joint-preserving method. It supports the collapsing subchondral plate by primary callus formation, reduces intra-osseous pressure, removes and replaces the necrotic segment, and adds viable cortical bone graft plus fresh cancellous graft, which has osseoinductive and osseoconductive potential. Factors predisposing to success are the aetiology, stage and size of the lesion. Furthermore, it is a hip-salvaging procedure in early pre-collapse stages, and a time-buying one when the femoral head has collapsed.






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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General