Vascularized bone grafts are for young patients with a femoral head properly formed and still in tact. Recover usually requires the use of  crutches or walker up to 24 weeks. The results are generally successful 80% of the time to prevent the eventual collapse of the femoral head. The successful operation is to prevent the eventual collapse of the femoral head over the area of necrotic bone and to enhance the rebuilding of the dead bone area.

In this operation the surgeon decompress the femoral head as in core decompression operation. The surgeon then continues with removal of the dead bone focus and replaces it with with patient's own fresh bone chips. He also places a viable piece of fibular bone from the smaller lower leg bone) to support the bone chips. Because the surgeon uses a living bone strut with vessels anastomosed to the vessels in the hip area, the transplanted strut is alive and offers a full support to the femoral head.

This is a difficult operation carried out by two teams of surgeons. One team makes the core decompression operation in the hip area while the second team removes the middle third of the fibula bone with the attached vessels. The diameter of these vessels is only 1 -2 millimeters.  This is a vascularized fibula graft. The fibula graft is placed into the core canal as a duvet. Then the hooking (anastomosis) of the very small vessels from the fibular graft to the vessels in the hip area is completed. Due to the small size of the vessels, this is painstaking work done under the operation microscope and taking several hours.

Healing and complete filling of the defect takes about 6 months, during which time the patient must be on crutches. The hospital stay is 2 - 4 days, the non-weight bearing for six weeks and restricted weight bearing up to 24 weeks follows.

Although the vascularized fibular graft is successful, there are several potential disadvantages:

This procedure is best for young patients under 50 years years old with a well retained surface of the femoral head and no damage to the joint cartilage. Patients with incipient osteoarthritis in the hip joint have usually worse results.