A 43 year old man presented to the Avascular Necrosis program at The Denver Clinic for Extremities at Risk with right hip pain that increases with physical activity.  He had no history that put him at risk for osteonecrosis but MRI revealed a Ficat Stage II lesion of his femoral head.   

Surgical options were discussed with the patient which included core decompression alone, core decompression with vascularized bone graft, and a hip resurfacing procedure.  Based on the level of activity he wanted to return to and the stage of disease currently he and the surgeon decided the best approach was to undergo a vascularized fibular graft procedure. 

The procedure was completed with the orthopedic surgeon completing the decompression of the femoral head and forming the trough for the vascularized fibula graft to fit into while the plastic surgeon was taking the fibular graft from the patient's lower right leg. Once the fibular graft was removed it was placed into the area the orthopedic surgeon prepared and the revascularization was completed.  The image shows the graft in place in the femoral head.

He was released from the hospital 2 days after the surgery and was slowly allowed to weight bear through his right leg.  He worked with a physical therapist to regain his hip and leg strength and now, 3 years after the surgery, is able to run comfortably on non-asphalt surfaces.