For this procedure, an incision is made at the level of the hip through which the dead (osteonecrotic) bone is removed much like a dentist would remove a cavity in your tooth.  This area at the top of the femur bone is contoured to allow placement of the vascularized bone graft.  This vascularized bone graft will bring in a new source of blood supply to the affected area and, in most cases, the bone consists of a piece of the patient's fibula. This requires that an incision is made in the lower leg to remove the segment of fibula and its attached blood vessels.  The fibular segment of bone is then inserted into the surgically created defect in the head of the femur.  Blood vessels in that region are connected to the vessel of the fibular graft with the help of a specialized microscope.  The circulation is then checked to ensure blood is flowing into the area before the wounds are closed.  This surgery is performed by an orthopedic and plastic/microvascular team.

MRI showing osteonecrosis of the femoral head	Xray following insertion of vascularized fibula into the femoral head