Microsurgery in femoral head osteonecrosis

The etiopathogenesis and clinical classification of the femoral head osteonecrosis are frequently discussed among the orthopedic field. The treatment options are even more debated as numerous solutions are described without clear correlation with the clinical picture. Among non-surgical and surgical options, vascularized bone grafts seem to be the more appropriate treatment in the early stages. Different donor sites have been described in the literature, but actually surgeons most frequently use free fibula flap. The implant of the fibula allows decompression at the level of the necrotic area, reducing the intraosseous hypertension of the femoral head, and at the same time it provides revascularization and restoration of an adequate blood flow to the femoral head, stopping the degenerative process and mechanically supporting the subchondral ischemic area. Although vascularized fibula graft treatment has reported encouraging results, it is a complex surgical technique. In accordance with the results of the literature, the stage of the disease at the time of surgery is the main factor determining the success or failure of the technique in terms of preservation of the femoral head. Other factors, which can be of fundamental importance from a prognostic point of view, are the etiology, the size of the necrotic area and the position of the fibula.