Osteonecrosis of the femoral head in immunosuppressed patients: Hip salvaging with implantation of a vascularised fibular graft

Osteonecrosis frequently occurs in patients being treated with steroids for conditions such as systemic lupus erythematosus and other collagen diseases and in renal transplant recipients. It remains an unsolved problem and can cause more disability than the underlying disease, particularly in young patients. In a series of eight young patients who received continuous corticosteroids and immunosuppressive agents, we attempted hip salvage in ten joints by implantation of a vascularised fibular graft into the necrotic femoral head. Follow‐up ranged from 18 to 36 months. Joints which were operated on prior to articular surface collapse had complete restoration of normal function. In patients with more advanced lesions, surgery resulted in a painless hip, improved range of motion, and cessation of further progress of the disease. The preliminary data are considered encouraging enough to suggest that the vascularised fibular graft is an appropriate method for hip salvage in immunosuppressed patients with osteonecrosis of the femoral head. © 1994 Wiley‐Liss, Inc.