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The Role and Benefits of Free Vascularized Fibular Grafts in Avascular Necrosis of the Hip

This CME activity discusses surgical options for patients with osteonecrosis of the hip, with a focus on free vascularized fibular grafting.

Available credits: 0.50

Time to complete: 30 minutes


Valid until:

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  • Overview

    CME Information

    Marc J. Richard, MD
    Orthopaedic Surgeon
    Duke University Medical Center 
    Durham, NC

    Activity Planners
    Meghan Coulehan, MPH
    Manager, Educational Strategy and Content
    Baltimore, MD

    Rebecca L. Julian, MS, ELS
    Senior Managing Editor
    Baltimore, MD

    Amy Sison
    Director of Continuing Medical Education
    Baltimore, MD

    Anne Jacobson, MPH, CCMEP/CHCP 
    Cocoa Beach, FL

    Activity Overview
    This CME-certified online publication discusses surgical options for patients with osteonecrosis of the hip, with a focus on free vascularized fibular grafting, a technique that was pioneered at Duke University Medical Center.

    Learning Objectives
    Upon completion, participants should be able to:

    • Explain the goals, benefits, and risks of free vascularized fibular grafting
    • Identify appropriate patient candidates for free vascularized fibular grafting 

    Target Audience
    This activity is intended for physicians, nurse practitioners, physician assistants, nurses, and pharmacists.

    Statement of Need
    Osteonecrosis of the femoral head (ONFH) is a debilitating bone disease that leads to destruction of the hip joint by early adulthood. Multiple joint-preserving procedures have been used to treat ONFH. Free vascularized fibular grafting (FVFG) is an effective option for salvaging the necrotic femoral head when performed prior to radiographic collapse in patients with ONFH. For those with postcollapse ONFH, FVFG can still improve joint function while delaying the need for total hip replacement. Clinicians need to understand recent advances and clinical options in hip surgeries for patients with ONFH. 

    Providership Statement
    Co-provided by Med-IQ® and the Duke University Health System Department of Clinical Education and Professional Development.


    Accreditation/Designation Statements
    Med-IQ is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. Med-IQ designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. 

    Others: Nurse practitioners, physician assistants, and other healthcare professionals who successfully complete the activity will receive a Statement of Participation indicating the maximum credits available.

    Medium/Method of Participation
    This CME activity consists of a 0.5-credit online publication. To receive credit, read the introductory CME material, read the publication, and complete the evaluation, attestation, and post-test, answering at least 70% of the post-test questions correctly.

    Original Release Date: July 15, 2015
    Rerelease Date: January 31, 2017
    Expiration Date: January 30, 2018
    Estimated Time to Complete This Activity: 30 minutes

    The evaluation, attestation, and post-test may be accessed by clicking the “Take Post-Test” tab above.

    Disclosure Policy
    Med-IQ requires any person in a position to control the content of an educational activity to disclose all relevant financial relationships with any commercial interest. The ACCME defines "relevant financial relationships" as those in any amount occurring within the past 12 months, including those of a spouse/life partner, that could create a conflict of interest (COI). Individuals who refuse to disclose will not be permitted to contribute to this CME activity in any way. Med-IQ has policies in place that will identify and resolve COIs prior to this educational activity. Med-IQ also requires faculty to disclose discussions of investigational products or unlabeled/unapproved uses of drugs or devices regulated by the US Food and Drug Administration.

    Disclosure Statement
    The content of this activity has been peer reviewed and has been approved for compliance. The faculty and contributors have indicated the following financial relationships, which have been resolved through an established COI resolution process, and have stated that these reported relationships will not have any impact on their ability to give an unbiased presentation.

    Marc J. Richard, MD
    Consulting fees/advisory boards: Acumed, DePuy Synthes, DJO Global, Medartis, OsteoMed
    Fees received for promotional/non-CME activities: Acumed, DePuy Synthes

    The writer, activity planners, and peer reviewers have no financial relationships to disclose.

    Statement of Evidence-Based Content
    Educational activities that assist physicians in carrying out their professional responsibilities more effectively and efficiently are consistent with the ACCME definition of continuing medical education (CME). As an ACCME-accredited provider of CME, it is the policy of Med-IQ to review and ensure that all the content and any recommendations, treatments, and manners of practicing medicine in CME activities are scientifically based, valid, and relevant to the practice of medicine. Med-IQ is responsible for validating the content of the CME activities it provides. Specifically, (1) all recommendations addressing the medical care of patients must be based on evidence that is scientifically sound and recognized as such within the profession; (2) all scientific research referred to, reported, or used in CME in support or justification of a patient care recommendation must conform to generally accepted standards of experimental design, data collection, and analysis.

    Med-IQ is not liable for any decision made or action taken in reliance upon the information provided through this activity.

    Contact Information
    For CME-related questions or comments about this activity, please contact Med-IQ. Call (toll-free) 866 858 7434 or e-mail

    Hardware/Software Requirements
    ReachMD requires a computer, tablet or mobile device and a connection to the Internet. For best results, a high-speed Internet connection is recommended (DSL/cable). We also recommend using the latest version of your favorite browser to ensure compliance with W3C standards, such as Internet Explorer, Microsoft Edge, Chrome, Firefox or Safari. Users accustomed to IE8/IE9/IE10 are advised to update their browsers for the best experience.

    Microsoft Internet Explorer 11.0 or later

    Mozilla Firefox - latest version

    Google Chrome - latest version

    Apple Safari - latest version

    PDF Viewer
    Adobe Acrobat Reader® or Adobe Reader

    Adobe Flash Player
    Adobe Flash Player 9 or later

    For technical support, go to 

    ADA Statement
    Med-IQ fully complies with the legal requirements of the ADA and the rules and regulations thereof. If any participant in this educational activity is in need of accommodations, please contact Med-IQ at 443 543 5200.

    The information provided through this activity is for continuing education purposes only and is not meant to substitute for the independent medical judgment of a physician relative to diagnostic and treatment options of a specific patient’s medical condition.

    Privacy Policy

    © 2017 Duke University Health System and Med-IQ®. All rights reserved.

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