More detailed description of free vascularized fibular grafting

Due to its high complexity, free vascularized fibular grafting for the hip is performed at only a few medical centers throughout the country by fellowship-trained Orthopaedic Surgeons, who are highly experienced with this procedure. Vascularized fibular grafting involves removal of dead bone from the “ball” of the hip that has poor or no blood supply and replacing it with a healthy, vascularized (blood-rich) bone from the lower leg, the fibula. A portion of the fibula (the smaller bone in the lower leg) is removed with its own blood vessels and then inserted into the “ball” of the hip. With use of a microscope, the blood vessels of the fibula are then attached to the blood vessels around the hip to restore blood flow to the “ball.”

The major advantage of a vascularized bone graft is that the bone placed into the hip is alive. This means an immediate blood supply along with living bone is inserted where dead bone was removed. Since the fibula bone graft becomes a strong living strut to help support the “ball” from collapse, a much larger amount of dead bone can be removed allowing for a better decompression and for improved ability to restore blood flow to the femoral head during the healing process. The fibula bone graft then fuses to the surrounding bone within the femoral head.

After vascularized fibular grafting surgery, the patient remains in the hospital for a few days and is typically discharged to home. Most importantly, protected weight-bearing must be maintained with the use of crutches or a walker for six months after surgery. No weight is allowed on the operated hip for the initial six weeks, and then gradual partial weight on the hip is permitted over the ensuing months. The aid of crutches is necessary for a total of six months to protect the hip from collapse as the bone graft heals. After six months of protecting the hip, full weight on the hip is allowed. To completely insure the success of surgery and proper healing, certain activities, such as running or sports, are on hold for about a year.

– From Avascular Necrosis Strikes Young Adults