Bone grafting with microvascular anastomosis in osteonecrosis of the femoral head.

Vascularized fibular grafting decompresses the femoral head, augments structural stability, and places healthy vascularized bone in the area of femoral head necrosis. Patients are selected for the procedure on the basis of symptomatology, age, mobility of the hip, and radiographic stage of the disease. Twenty-four patients were reviewed in the current report. Mean patient age was 33. Seven patients had stage II disease, 4 patients had stage III disease, 10 had early (less than 2 mm collapse) stage IV disease, and 1 had stage V disease. The mean follow-up was 32.8 months (range, 24-54 months). Five procedures failed. The remaining patients have had gratifying results in terms of pain relief, functional improvement, and cessation of disease progression. Longer follow-up will determine if vascularized fibular grafting alters the natural history of the condition and if vascularization of the fibular bone graft offers superior results to those obtained in the past with nonvascularized grafts.