Eight‐year follow‐up after vascularized fibular epiphyseal transfer for hip reconstruction

The purpose of this letter is to provide a clinical and radiological update, eight years after the original surgery, on the already-reported case of a 4-year-old child who underwent a modified vascularized fibular epiphyseal transfer (VFET) for hip reconstruction post tumor resection (Soldado et al., 2012). A second proximal femoral osteotomy was performed to address the coxa vara deformity five years after the initial operation. Osteotomy union was achieved four months later, which illustrates the capacity of the extension of the VFET with a vascularized periosteal flap to facilitate structural bone allograft revascularization and integration. At last follow-up visit, when the child was 12 years old, the child exhibited a subtle Trendelenburg gait and 11 mm of limb length discrepancy. However, he walked pain-free with full weight bearing and was able to run (Supporting Information Video 1). The VFET grew 38 mm in length while the metaphysis and epiphysis enlarged 250% and 200%, respectively, relative to the contralateral proximal fibula, representing 70% and 93% of the metaphysis and epiphysis of the contralateral femur respectively. Magnetic resonance imaging (MRI) revealed enlarging and three-dimensional remodeling of the neoepiphysis (Figure 1). Passive hip range of motion was 408 for flexion, 08 for extension, 08 for abduction, 108 for adduction, and 08 and 208 for internal and external rotation, respectively. Only five additional cases have been reported in which a VFET was used for proximal femoral reconstruction, with six years the longest follow-up. Hence, there is limited information about the durability of this procedure. Our patient experienced very similar outcomes as previously-reported cases of VFET, including exceptional epiphyseal and metaphyseal remodeling, but just limited hip range of motion (Debarge, Chotel, Gazarian, Viola, & Berard, 2009; Innocenti, Delcroix,