Functional and HIP survivorship outcomes of free Vascularized fibula graft in the management of post COVID-19 Osteonecrosis of femur head: A prospective case series.

Abstract

To evaluate functional and radiological outcomes of Free Vascularized Fibula grafting in management of Covid-19 associated Osteonecrosis of Femur Head. Prospective Case Series. 14 hips (10 patients) with ONFH following COVID-19 were treated with Free Vascularized Fibula graft from June 2021 to December 2022 and were subsequently evaluated monthly for 6 months and then every 3 months post operatively for functionality (Harris Hip Score), Femur head collapse and related complications. Mean age of patients was 29.3 years (Range: 20-38 years). 14 diseased hips were classified on the basis of Steinberg classification as 4 stage 2B, 4 stage 3B and 6 stage 3C. The average follow up period was 2.1 years (Range: 12 months-34 months).Eight of fourteen hips survived and six progressed to collapse. Mean HHS at final follow-up was 68.3 in comparison to 65.8 pre-operatively. 4 fair and 4 poor HH scores were converted to 4 excellent and 4 good scores post-operatively.Two late complications were noted-one FHL contracture and one CPN neuroma. Free Vascularized Fibula Graft, as a hip salvage modality, showed optimal results in the treatment of COVID-19 related ONFH, which is associated with aggressive disease course and extensive involvement of femur head.