A Comparative Study of Hips Treated with Core Decompression Versus Vascularized Fibular Graft for Avascular Necrosis: A Survival Analysis.

Abstract

Objective: To compare the effectiveness of core decompression and vascularized fibular grafting in terms of pain relief, functional recovery, prevention of disease progression, and short-term hip survival.
Methodology: This prospective observational comparative study was executed in department of orthopedic surgery, Shifa International hospital, Islamabad, from august 2025 to march 2026. Seventy-six patients were enrolled, with 38 in each group; those lost to follow-up were excluded from final analysis. Adults aged 18 to 60 years with radiologically con-firmed Association Research Circulation Osseous classification (ARCO) stage II or III avascular necrosis were included.
Results: A total of 61 patients were analyzed, including 32 treated with core decompression and 29 with vascularized fibular grafting. Baseline age, preoperative Harris Hip Score (HHS) and preoperative visual analog scale pain score were comparable between groups. At 6 months, HHS remained higher (81.79 ±10.41 vs 74.75 ±12.83, p=0.023) and pain score remained lower (2.20 ± 1.16 vs 3.77 ±1.54, p<0.001) in the graft group. Disease progression, arthroplasty conversion, and Kaplan-Meier survival showed favorable but non-significant trends for grafting.
Conclusion: Vascularized fibular grafting demonstrated superior early outcomes compared to core decompression in patients with avascular necrosis of the femoral head, particularly in terms of functional recovery and pain relief. Although trends also favored grafting for disease progression and short-term hip survival, these differences did not reach statisti-cal significance within the 6‑month follow-up period.
Keywords: Avascular necrosis, core decompression, vascularized fibular graft, survival analysis.