We present a novel arthroscopic-assisted technique to graft chondral defects and subchondral cysts of the acetabular socket using a synthetic osteochondral plug. Four patients with groin pain,solitary cysts in the roof of the acetabulum and radiographic evidence of early osteoarthritis were treated. A bone tunnel was prepared from the region of the iliac crest to the acetabular articular surface.A synthetic osteochondral plug was inserted in an ante-grade fashion and positioned flush with the lunate articular cartilage. The minimum follow-up from surgery was 8 months (mean 10 months,range 8 to 11 months). There were no peri-operative complications related to the procedure. All patients reported an improvement in symptoms and function at the latest follow-up. One of the patients underwent a re-look arthroscopy at 5 months for persistent dull groin and buttock pain. Capsular adhesions of the labrum were identified and released. The mean non-arthritic hip score improved from 53.8 (range 43.8 to 70) pre-operatively to 84.6 (range 78.8 to 87.5) at 6 months. Computed tomography and magnetic resonance imaging at 6 months confirmed the stability of the osteochondral plugs and on-going healing. This procedure offers an arthroscopic means to treat patients with solitary acetabular cysts and may prove effective for chondral grafting of denuded acetabular areas in early to moderate degenerative hip disease.

Developmental dysplasia of the hip predisposes to premature degenerative hip disease. A number of operations have been described to improve acetabular cover and have achieved varying degrees of success. We present the case of an 84-year-old woman, who underwent a shelf procedure to reconstruct a dysplastic hip 75 years ago. To date, the shelf remains intact and the hip is asymptomatic. We believe this represents the longest documented outcome of any procedure to stabilise the hip.

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