Department of Orthopedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Eur J Orthop Surg Traumatol. 2023 Aug;33(6):2347-2352. doi: 10.1007/s00590-022-03440-7. Epub 2022 Nov 21.
Total hip arthroplasty (THA) after vascularized fibular grafting (VFG) is technically demanding with poorer outcomes compared to primary THA in patients with osteonecrosis of the femoral head (ONFH). The purpose of this study was to compare the outcomes of THA after VFG after removal of the graft with that of primary THA.
ONFH patients treated by VFG at a single institution were studied retrospectively. THAs after VFG performed by single arthroplasty surgeon with a single type of THA prosthesis were enrolled in the study. A control cohort of patients was created by 1:1 matching with the THA after VFG cohort according to age, gender, and American Society of Anesthesiology (ASA) score from ONFH patients treated by primary THA. Early and long-term outcomes were compared between the two groups.
A total of 24 hips were included in the THA after VFG group and compared with 24 primary THA hips. No significant difference was noted in stem position. The THA after VFG group had increased blood loss and longer duration of operation time. There were two cases of intraoperative femur fractures in the THA after VFG group. The femoral stem of both groups were stable, with no cases of revision, and similar HHS scores at the last follow-up.
THA after VFG may have similar short to midterm outcomes with primary THA after removal of the residual abutting bone graft and correct positioning of the femoral stem.
与原发性全髋关节置换术（THA）相比，带血管腓骨移植（VFG）后行全髋关节置换术（THA）在技术上要求较高，且在股骨头坏死（ONFH）患者中的疗效较差。本研究旨在比较 VFG 后去除移植物的 THA 与原发性 THA 的疗效。
回顾性研究单中心接受 VFG 治疗的 ONFH 患者。本研究纳入了由同一位关节置换外科医生使用同种 THA 假体进行 VFG 后 THA 的患者。通过 1:1 与接受原发性 THA 的 ONFH 患者根据年龄、性别和美国麻醉医师协会（ASA）评分匹配，创建了 VFG 后 THA 组的对照组。比较两组患者的早期和长期疗效。
共纳入 24 例 VFG 后 THA 组和 24 例原发性 THA 组。两组患者的股骨柄位置无显著差异。VFG 后 THA 组术中出血量和手术时间较长。VFG 后 THA 组有 2 例术中股骨骨折。两组股骨柄均稳定，均未行翻修，末次随访时 HHS 评分相似。
去除残余贴合骨移植物并正确定位股骨柄后，VFG 后 THA 可能具有与原发性 THA 相似的短期至中期疗效。
