Summary
5-year outcomes after biocartilage use for treatment of cartilage defect in hip
Abstract
Introduction
Recently, a biologic scaffold combining allograft cartilage and autologous platelet-rich plasma (BioCartilage®) has been introduced to augment microfracture treatment of symptomatic chondral defects of the hip. The purpose of the study is to evaluate rates of achieving meaningful outcomes and clinical failure at 5-year after undergoing microfracture augmented with BioCartilage, and identify variables predictive of requiring clinical failure.
Methods
Data from a prospective series of consecutive patients with Outerbridge grade IV chondromalacia of the acetabulum or femoral head who underwent hip microfracture augmented with BioCartilage between January 2017 and August 2019 was analyzed. Patient-reported outcomes were collected preoperatively and at minimum one-year postoperatively. The Hip Outcome Score- Activity of Daily Living (HOS-ADL), -Sports Subscale (HOS-SS), modified Hip Harris Score (mHHS), and Non-Arthritic Hip Score (NAHS) thresholds for achieving the minimal clinically important difference (MCID), patient acceptable symptomatic state (PASS), and substantial clinical benefit (SCB) at 5-year after surgery were calculated. Regression analysis was perfomed to identify whether demographics and cartilage defect size was predictive of clinical failure.
Results
A total of 79 patients (84%) had 5-year follow up, and were included in the final analysis. The combined mean age and BMI was 37.1+10.1 years and 27.1+4.5, respectively, and had a mean follow-up time of 69.9+8.7 months. The average chondromalacia area was 193.6+103.9, with 70 patients (94.6%) and 13 The average acetabular head and femoral chondromalacia area treated was 201.8+111.3mm2 and 164+70.6mm2, respectively. There was a statistically significant improvement in all functional score averages over the 5-year time period (p<0.05). A total of 84.6%, 87.9%, and 77.3% reached at least one threshold for achieving MCID, PASS, or SCB respectively. Of the 79 hips in the analysis, 12(15.2%) underwent conversion to total hip arthroplasty (THA) at an average of 31.3+21.7 months from hip arthroscopy. Lastly, the regression analysis demonstrated that older age was statistically predictive of conversion to THA (p-value: 0.013).
Conclusion
Patients undergoing microfracture with BioCartilage augmentation for acetabular or femoral head chondromalacia demonstrated high rates of achieving meaningful outcome at 5-year follow-up regardless of chondromalacia defect size. While 15.2% required conversion to THA, the majority of patients achieved clinical success indicating this novel technique provides optimal mid-term outcomes.