The Vascularized Fibular Graft in the Treatment of Osteonecrosis: Rationale, Surgical Technique, and Effectiveness

Vascularized fibula grafting (VFG) has been used as an effective intervention for treating osteonecrosis of the femoral head (ONFH), particularly in cases with precollapse stages and significant necrotic lesions. Introduced by Urbaniak et al. in 1979, VFG aims to arrest necrosis progression through enhanced revascularization, providing both structural support and biological reconstruction of the femoral head without the need for creeping substitution. The procedure involves meticulous surgical technique to remove necrotic bone and insert a vascularized fibula, ensuring optimal graft viability and positioning. Clinical outcomes have demonstrated VFG’s effectiveness over conventional treatments like core decompression and non-vascularized fibula grafting, showing better preservation of femoral head sphericity, improved Harris hip scores, and longer-term radiographic stability. The success of VFG underscores its role in extending graft survival and delaying the need for total hip arthroplasty, particularly beneficial for younger patients with ONFH.