2015 ISAKOS Biennial Congress ePoster #813

Treatment of Osteochondral Defects of the Femoral Head with Autologous Osteochondral Autograft Transfer Using a Safe Surgical Hip Dislocation

Mehmet Arazi, Prof., MD, Meram/Konya, KONYA TURKEY
Yusuf Aksoy, MD, AFYON TURKEY
Sezgin Simsek, KONYA TURKEY

FARABI KLINIK ORTOPEDI VE TRAV. KLINIGI, KONYA, TURKEY

FDA Status Cleared

Summary: In this retrospective study, we present the early and satisfactory results of the autologous osteochondral autograft transfer using by safe hip dislocation for osteochondral defects of the femoral head in younger and physically active patients.

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Abstract:

Introduction

The treatment of osteochondral defects of the femoral head is challenging both for patients and physicians. In the elderly total hip arthroplasty is the golden standard. Recently joint preserving surgical methods have been popularized for hip problems in younger and physically active patients. We present the early results of the mosaicplasty for chondral lesions of the femoral head in younger patients.

Aim

of the study:
We aimed to show early results of the treatment of osteochondral defects of the femoral head treated with mosaicplasty.

Materials And Methods

Between April 2010 and September 2013, five patients with osteochondral lesions of the femoral head were treated with autologous osteochondral transfer (mosaicplasty) were included in the study. There were one female and four male patients and their average age was 26.6 years (range 16 to 42). Plain radiographs and magnetic resonance imaging studies were analyzed in all patients. There was no joint narrowing; flattening of the femoral head and involvement of the acetabular cartilage was unipolar in all of the patients. Two patients had traumatic injuries and three cases were idiopathic. The idiopathic cases were heavy smokers. The patients were treated with safe dislocation of the hip described by Ganz et al. under general anesthesia, in lateral decubitus position. The hip was dislocated anteriorly after trochanteric flip osteotomy and Z capsulotomy of the affected hip. The chondral lesion was delineated and the defect was prepared using mosaicplasty instruments. Autologous osteochondral grafts were harvested from the ipsilateral knee and implanted to the defect on the femoral head. The grafts were implanted in a press-fit fashion and the head sphericity was reconstructed. The patients were followed clinically and radiologically at 1, 3, 6 and 12 months after the operation. MRI of the hip was obtained at one year. Harris hip score was used for clinical evaluation.

Results

All patients were followed up for at least one year (average: 16 months, range 12 to 50). All trochanteric osteotomies healed without complications. No major complications were encountered. At one year follow-up all patients could walk without walking aids. The head sphericity and graft incorporation were obtained in all patients except one according to the radiographical and MRI studies. One patient showed minimal flattening of the head without any pain at his final evaluation. The patients’ Harris hip score was 42 at the preoperative evaluation and 94 at the final follow-up evaluation. All patients were pain free and had full range of motion in the hip.

Conclusion

This study showed that the use of autologous osteochondral transfer using a safe surgical hip dislocation is a viable alternative treatment option in younger and very active patients with osteochondral defects of the femoral head without severe arthritic changes.