The vascularized fibular graft in the treatment of osteonecrosis: Data, dogma, and controversies

In the debate about surgical treatment for osteonecrosis of the femoral head (ONFH), no topic is more frequently debated than the use of the free vascularized fi bular graft (FVFG) as a standard treatment. Pioneered by Urbaniak in 1979, the FVFG represents a durable, biologic means of reconstructing the femoral head after removal of the osteonecrotic bone [ 1 ]. However, this technique has been criticized for its complexity and is only widely performed at several centers throughout the world. Small numbers of cases treated operatively, diffi culty comparing uniform cases of ONFH, and the proclivity of many surgeons to utilize one particular operation preferentially have rendered direct comparison of FVFG to other techniques an unwieldy prospect [ 2 ]. What is agreed upon is that the goal of therapy should be to delay the progression of osteonecrosis as well as repair it. This chapter will focus upon how the FVFG addresses these goals, how it performs, and how it compares – indirectly at least – with other options such as core decompression, tantalum rod instrumentation, nonvascularized bone grafting, and corrective osteotomies.

Duke Scholars

Author William Curtis Eward Orthopaedic Surgery