Vascularized fibular grafts in patients with avascular necrosis of femoral head: a systematic review and meta-analysis
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ORTHOPAEDIC SURGERY
Vascularized fibular grafts in patients with avascular necrosis of femoral head: a systematic review and meta-analysis Taolin Fang • Elizabeth W. Zhang • Frederick C. Sailes • Robert A. McGuire William C. Lineaweaver • Feng Zhang
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Received: 17 July 2012 / Published online: 18 October 2012 Ó Springer-Verlag Berlin Heidelberg 2012
Abstract Background Vascularized fibular grafting (VFG) has been initiated to treat avascular necrosis of the femoral head (ANFH) since the late 1970s. There are a number of review articles updating the use of VFG to treat the ANFH. None of them applied statistical analysis for combining results from different studies to obtain a quantitative estimate of the overall effect and potential harm of VFG in comparison to other treatment. Methods Several electronic databases were searched to find studies using VFG to treat ANFH. The outcomes sought included Harris Score, failure rate (conversion to total hip arthroplasty (THA) and/or femoral head collapse), and complications rate. Included studies were assessed for methodological bias and estimates of effect were calculated. Potential reasons for heterogeneity were explored. Results The clinical results of 69.0 % of VFG-treated patients and 25.0 % of non-VFG-treated patients were good to excellent (OR 0.13; p \ 0.01). The conversion rate
T. Fang (&) Department of Orthopedic Surgery, Zhongshan Hospital, Fudan University, 200032 Shanghai, China e-mail: [email protected] T. Fang E. W. Zhang F. C. Sailes F. Zhang (&) Division of Plastic Surgery, University of Mississippi Medical Center, Jackson, MS 39216, USA e-mail: [email protected] R. A. McGuire Department of Orthopedic Surgery, University of Mississippi Medical Center, Jackson, MS 39216, USA W. C. Lineaweaver JMS Burn and Reconstructive Center, Crossgates River Oaks Hospital, Brandon, MS 39042, USA
to THA of VFG-treated and that of other methods treated hips was 16.5 % and 42.6 % (OR 0.19; p \ 0.001). Collapse rate of VFG-treated and that of non-VFG-treated hips was 16.7 % and 63.6 % (OR 0.09; p \ 0.05). The complication rate of VFG-treated and that of other methods treated patients was 23.8 % and 8.9 % (OR 3.44; p = 0.09). For Steinberg stage I, II ANFH, failure rate of VFG-treated and that of non-VFG-treated hips was 9.8 % and 40.2 % (OR 0.17; p \ 0.001). For Steinberg stage II, III ANFH, failure rate of VFG-treated and that of nonVFG-treated hips was 16.5 % and 42.8 %, respectively (OR 0.17; p \ 0.001). Conclusions VFG is a justified method that can prevent the ANFH from progressing to collapse, and that can retard or avoid hip replacement, especially in the hips of Steinberg stage I, II, and III. Keywords Avascular necrosis of femoral head Vascularized bone graft Vascularized fibular graft Meta-analysis
Introduction Avascular necrosis of the femoral head (ANFH) is a debilitating disease that usually leads to destruction of the hip joint in patients who are in the third, fourth, or fifth decades of life. It has been estimated to 10,000–20,000 new patients a year i
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