![\"MRI](\"https:\/\/2025divi.cortho.org\/wp-content\/uploads\/2021\/08\/Role-of-Fibular-Bone-Graft.jpg\" "\\"MRI")
MRI in the coronal section showing avascular necrosis lesions in both hips.<\/p><\/div>\n
Biomechanics or Physiology<\/h3>\n
In AVN, the loss of blood supply to the femoral head leads to bone death and the collapse of the femoral head. This collapse causes mechanical failure in the hip joint, resulting in pain, stiffness, and functional limitations. Fibular bone grafting works by addressing the bone collapse and restoring blood flow to the affected area. The fibula, a bone from the lower leg, is harvested and inserted into the femoral head to provide structural support and a vascular supply that can promote bone regeneration. The fibula\u2019s bone cells gradually replace the necrotic bone through a process known as creeping substitution, wherein the graft tissue is replaced by new, healthy bone over time.<\/p>\n
Common Variants and Anomalies<\/p>\n
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Early-stage AVN<\/strong>: When detected early, fibular bone grafting<\/strong> may prevent femoral head collapse and delay the need for total hip replacement<\/strong>.<\/p>\n<\/li>\n
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Late-stage AVN<\/strong>: If the bone collapse is severe or if there is significant joint damage, total hip replacement<\/strong> is usually indicated.<\/p>\n<\/li>\n
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Vascularized fibular grafting<\/strong>: This technique involves transferring fibular bone<\/strong> along with its blood vessels<\/strong>, ensuring an enhanced blood supply to the femoral head and improving the chances of bone regeneration.<\/p>\n<\/li>\n
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Non-vascularized grafts<\/strong> are less effective in restoring bone health and may only provide structural support.<\/p>\n<\/li>\n<\/ul>\n
Clinical Relevance<\/h3>\n
Fibular bone grafting is a valuable treatment option for young patients with early-stage AVN who wish to avoid immediate joint replacement. It can help preserve the femoral head, delay the need for total hip replacement, and potentially restore normal hip function. However, the success of this procedure is not guaranteed, and AVN may progress despite intervention. This highlights the importance of careful patient selection, as well as the consideration of implant replacement surgery as a long-term solution, especially when conservative options fail.<\/p>\n
Imaging Overview<\/h3>\n
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X-rays<\/strong>: The primary imaging modality used to assess the femoral head<\/strong> for signs of AVN. Subchondral sclerosis<\/strong> (hardening of the bone) and joint space narrowing<\/strong> are indicative of advanced AVN.<\/p>\n<\/li>\n
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MRI<\/strong>: The most sensitive test for detecting early-stage AVN<\/strong>. MRI can identify bone marrow edema<\/strong> (swelling) in the femoral head, which is often the first sign of AVN before bone collapse occurs.<\/p>\n<\/li>\n
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CT scans<\/strong>: Used to visualize bone collapse<\/strong> and evaluate the extent of damage to the femoral head.<\/p>\n<\/li>\n
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Bone scans<\/strong>: Can detect early changes in bone metabolism, such as increased uptake<\/strong> in the femoral head, indicating AVN.<\/p>\n<\/li>\n<\/ul>\n
Associated Conditions<\/h3>\n
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Corticosteroid use<\/strong>: Long-term use of glucocorticoids for conditions such as rheumatoid arthritis<\/strong>, systemic lupus erythematosus<\/strong>, or nephrotic syndrome<\/strong> is a major risk factor for developing AVN.<\/p>\n<\/li>\n
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Trauma<\/strong>: Hip fractures<\/strong> or dislocations<\/strong> can damage blood vessels supplying the femoral head, leading to AVN.<\/p>\n<\/li>\n
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Alcohol abuse<\/strong>: Chronic alcohol consumption can disrupt blood flow to the femoral head, increasing the risk of AVN.<\/p>\n<\/li>\n
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Other systemic diseases<\/strong>: Sickle cell disease<\/strong> and vascular disorders<\/strong> can also contribute to AVN by impairing blood supply to the hip.<\/p>\n<\/li>\n<\/ul>\n
Surgical or Diagnostic Applications<\/h3>\n
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Core decompression<\/strong>: A procedure in which a small section of the femoral head is removed to reduce internal pressure and stimulate revascularization.<\/p>\n<\/li>\n
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Fibular bone grafting<\/strong>: A non-surgical<\/strong> approach in which the fibula<\/strong> is harvested and implanted into the femoral head. The vascularized fibular graft<\/strong> enhances blood supply<\/strong> to the necrotic bone, encouraging healing.<\/p>\n<\/li>\n
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Total hip replacement (THR)<\/strong>: The most common treatment for late-stage AVN<\/strong> or advanced bone collapse<\/strong>, where the femoral head is replaced with an artificial joint.<\/p>\n<\/li>\n
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Stem cell therapy<\/strong>: An experimental treatment option aimed at regenerating bone tissue using stem cells<\/strong> derived from the patient’s own body.<\/p>\n<\/li>\n<\/ul>\n
Prevention and Maintenance<\/h3>\n
While AVN cannot always be prevented, certain steps may reduce the risk:<\/p>\n
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Minimizing corticosteroid use<\/strong> whenever possible or using the lowest effective dose for the shortest period.<\/p>\n<\/li>\n
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Maintaining bone health<\/strong> through calcium<\/strong>, vitamin D<\/strong>, and weight-bearing exercises.<\/p>\n<\/li>\n
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Regular monitoring<\/strong> of patients on corticosteroid therapy for early signs of AVN.<\/p>\n<\/li>\n
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Early diagnosis<\/strong> through MRI<\/strong> or bone scans<\/strong> allows for prompt intervention before femoral head collapse occurs.<\/p>\n<\/li>\n<\/ul>\n
![\"Removed](\"https:\/\/2025divi.cortho.org\/wp-content\/uploads\/2021\/08\/Role-of-Fibular-Bone-Graft-2.jpg\" "\\"Removed")
Removed head of femur during surgery showing avascular necrotic lesion.<\/p><\/div>\n
Research Spotlight<\/h3>\n
A recent study assessed the outcomes of core decompression (CD) with or without nonvascularized fibular grafting in early-stage avascular necrosis (AVN) of the femoral head. The study included 76 hips, with Stage 1 patients undergoing CD alone and Stage 2 patients receiving CD with fibular grafting.<\/p>\n
At an average follow-up of 53.5 months, the study found that 72.3% of hips showed no progression of the disease. However, 27.6% of cases demonstrated disease progression, with a higher failure rate in the fibular grafting group (30%) compared to CD alone (25%).<\/p>\n
The study concluded that while CD with fibular grafting can delay disease progression and help preserve the femoral head, it does not entirely prevent further collapse or arthritis, emphasizing the importance of early intervention in the disease’s progression. (“Study on core decompression and fibular grafting for AVN \u2013 see PubMed<\/em><\/a>“).<\/p>\n
\u00a0<\/p>\n
Summary and Key Takeaways<\/h3>\n
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Avascular necrosis (AVN)<\/strong> of the femoral head is a progressive condition that can lead to pain and loss of joint function if untreated.<\/p>\n<\/li>\n
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Corticosteroid use<\/strong> is the most common cause of AVN, particularly in young, middle-aged adults.<\/p>\n<\/li>\n
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Early-stage AVN can be managed with core decompression<\/strong>, fibular bone grafting<\/strong>, and stem cell therapy<\/strong>, potentially delaying the need for total hip replacement<\/strong>.<\/p>\n<\/li>\n
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Total hip replacement<\/strong> is the gold standard for advanced AVN, providing excellent pain relief and joint function.<\/p>\n<\/li>\n
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Early diagnosis<\/strong> through MRI<\/strong> and bone scans<\/strong> is crucial for preserving the femoral head and preventing further joint damage.<\/p>\n<\/li>\n<\/ul>\n
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Role of Fibular Bone Graft in theTreatment of Avascular Necrosis Avascular necrosis (AVN), also known as osteonecrosis, is a debilitating condition that affects the femoral head, leading to bone death due to compromised blood supply. It is most common in young and middle-aged adults, often causing pain, deformity, and limp. Fibular bone grafting is one […]<\/p>\n","protected":false},"author":37,"featured_media":13832,"parent":162,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_seopress_robots_primary_cat":"","_seopress_titles_title":"Bone Graft of Treatment of Avascular Necrosis | Complete Orthopedics","_seopress_titles_desc":"Avascular necrosis of the head of the femur is a debilitating disease that affects middle-aged and young adults.","_seopress_robots_index":"","_et_pb_use_builder":"on","_et_pb_old_content":"
Avascular necrosis of the head of the femur <\/a>is a debilitating disease that affects middle-aged and young adults. The disease is also known as osteonecrosis and may progress rapidly to cause hip pain, deformity, and limp. The management of late-stage avascular necrosis is joint replacement surgery.<\/p>
In younger patients with early stages of avascular necrosis, head-saving procedures such as vascularized bone grafting may be done. The procedure is mainly done to delay the need for joint replacement surgery, however, with the advancement of implant technology and design, hip replacement<\/a> surgeries offer excellent results even in young patients.<\/p>[caption id=\"attachment_13832\" align=\"aligncenter\" width=\"500\"]
<\/a> MRI in the coronal section showing avascular necrosis lesions in both hips.[\/caption]Avascular necrosis occurs as a result of bone death in the head of the femur. Bone death occurs due to disruption of the blood supply of the head of the femur. The disruption of the blood supply may occur as a result of direct trauma to the hip. Traumatic hip dislocations and fractures are commonly associated with avascular necrosis of the hip joint.<\/p>
Long-term use of corticosteroids<\/a> for medical diseases such as nephrotic syndrome, rheumatoid arthritis, etc, or secondary to abuse in athletes may lead to avascular necrosis. Avascular necrosis may also occur in patients with a history of alcohol abuse<\/a>.<\/p>
In the initial stages of avascular necrosis, there may not be any symptoms and the disease may only be diagnosed on a bone scan or an MRI. With the advancement of the disease, the patient may complain of groin pain that occurs on activity and as well on rest.<\/p>
During the early stages before the collapse of the head of the femur, attempts are made to preserve the head of the femur. The preservation is aimed to decrease the pressure inside the head of the femur, revitalize the blood supply of the necrotic area, and prevent the collapse of the head of the femur.<\/p>
The head preservation surgeries include core decompression<\/a>, stem cell implantation<\/a>, and bone grafts. With core decompression, the physician tries to reduce the pressure inside the head of the femur and prevent further advancement of the disease. Stem cell therapy in the form of bone marrow graft is done to possibly revitalize the blood supply.<\/p>
Strut bone grafts such as fibular bone grafts provide not only graft material but also provide structural support to the head of the femur to prevent collapse. Vascularized fibular grafts additionally provide nutrients to the bone graft and are hypothesized to replace the necrotic bone with new bone through creeping substitution.<\/p>
The fibula is the smaller of the two bones in the leg of the human. The fibula is present on the outer side of the leg. The graft is taken from the middle of the fibula leaving an adequate amount of bone at both ends to continue to provide structural support to the joints of the leg.<\/p>
The surgeon harvests the graft along with the blood vessels of the bone. The surgeon then passes a wire from the side of the hip joint and serially reams the neck and head of the femur without breaching the subchondral region. The reaming helps to reduce the pressure inside the head of the femur.<\/p>
The fibular graft is then passed inside the track formed inside the head and neck. A microsurgery technique is then used to attach the graft blood vessels to nearby blood vessels. The blood supply to the graft not only helps to maintain the graft integrity but also brings in bone cells that may slowly replace the dead bone in the head of the femur with new bone.<\/p>
After the surgery, the patient is advised to follow precautions to protect the graft and to start physiotherapy to aid in early return back to daily activities. At 6 weeks the patients may start protected weight-bearing and slowly progress to complete weight-bearing.<\/p>
The surgery although aims to preserve the head of the femur, avascular necrosis may still progress. The fibular graft surgery potentially however delays the need for joint replacement surgery. However, with improved techniques and outcomes, joint replacement surgery may be indicated even in young patients.<\/p>[caption id=\"attachment_13831\" align=\"aligncenter\" width=\"375\"]
<\/a> Removed head of femur during surgery showing avascular necrotic lesion.[\/caption]The joint replacement surgery alleviates the pain and deformity associated with avascular necrosis. Modern implants last on an average of 20 years or more and patients who may need eventual arthroplasty after vascularized bone graft are better suited for a primary arthroplasty.<\/p>","_et_gb_content_width":"","footnotes":""},"class_list":["post-13830","page","type-page","status-publish","has-post-thumbnail","hentry"],"_links":{"self":[{"href":"https:\/\/2025divi.cortho.org\/index.php?rest_route=\/wp\/v2\/pages\/13830","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/2025divi.cortho.org\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/2025divi.cortho.org\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/2025divi.cortho.org\/index.php?rest_route=\/wp\/v2\/users\/37"}],"replies":[{"embeddable":true,"href":"https:\/\/2025divi.cortho.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=13830"}],"version-history":[{"count":3,"href":"https:\/\/2025divi.cortho.org\/index.php?rest_route=\/wp\/v2\/pages\/13830\/revisions"}],"predecessor-version":[{"id":58604,"href":"https:\/\/2025divi.cortho.org\/index.php?rest_route=\/wp\/v2\/pages\/13830\/revisions\/58604"}],"up":[{"embeddable":true,"href":"https:\/\/2025divi.cortho.org\/index.php?rest_route=\/wp\/v2\/pages\/162"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/2025divi.cortho.org\/index.php?rest_route=\/wp\/v2\/media\/13832"}],"wp:attachment":[{"href":"https:\/\/2025divi.cortho.org\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=13830"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
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