Fresh-stored osteochondral allografts for the treatment of femoral head defects: surgical technique and preliminary results

Abstract

Purpose The purpose of this study was to present the preliminary clinical and radiographic outcomes of the treatment of femoral head osteochondral defects in eight consecutive symptomatic patients with fresh-stored osteochondral allografts via a trochanteric osteotomy. Methods This study included all consecutive patients treated in our department between 2008 and 2010 for worsening pain and mechanical symptoms of femoral head osteochondral defects. Each patient had preoperative routine hip radiographs and a preoperative magnetic resonance imaging study that determined and recorded the defect size and femoral head diameters. Allograft donors were identified through the Multiple Organ Retrieval and Exchange program (Ontario, Canada). Results The osteochondral defects were secondary to osteochondritis dissecans in four patients, avascular necrosis in three and femoral head fracture without dislocation in one. The patients' average age at surgery was 23.7 (range 17-42), and the average follow-up was 41 months (range 24-54). Follow-up included clinical and radiographic examinations at standard intervals. The average Harris hip scores improved from 57.7 (range 50-65) points preoperatively to 83.9 (range 72-94) points at latest follow-up. Five patients had good-toexcellent clinical outcomes, and one had a fair outcome. One patient was converted to a total hip arthroplasty due to progression of arthritis. Another patient's graft subsided and he underwent a successful repeat transplantation. An additional patient required the removal of the screws transfixing her trochanter due to persistent irritation. Conclusions These findings indicate that fresh-stored osteochondral allograft transplantation using a trochanteric slide and surgical dislocation is a viable treatment option for femoral head defects in young patients.

Arthroplasty for unstable pertrochanteric hip fractures may offer a lower re-operation rate as compared to cephalomedullary nailing

“…A modified trochanteric slide osteotomy was used to expose the hip joint, as unstable pertrochanteric fractures with fracture lines at or below the rough line of the greater trochanter (AO/OTA Type A2.2, A2.3 and A3) are particularly amenable to this approach [15]. The trochanteric slide osteotomy has been developed specifically for complex arthroplasty procedures and provides excellent exposure for complex arthroplasty surgery [16,17]. Briefly, a coronal oriented osteotomy commencing lateral to the insertion of the posterior capsule and external rotators is performed using an oscillating saw.…”

Optimising femoral-head osteochondral allograft transplantation in a preclinical model

“…The procedure does appear to improve the Harris hip scores [5] , [6] . Kosashvili et al [6] reported on eight patients with up to 24-months follow up and showed a 26.2 average improvement in Harris hip scores. Six out of eight (75%) patients had “good mobility” and had functional grafts at 42 months.…”

“…Osteochondral allograft (OCA) transplantation has been extensively used and studied for the treatment of large articular defects of the human knee with good to excellent long-term results reported [1] , [2] , [3] . OCA transplantation for the treatment of femoral-head defects in human patients has also been described, but only in the form of case reports or small case series [4] , [5] , [6] , [7] . The largest case series in the peer-reviewed literature is from 1985, and reported that OCA transplantation of the femoral head for the treatment of post-traumatic femoral-head defects, avascular necrosis without segmental collapse, osteochondritis dissecans, and tumours to be associated with an 80% long-term success rate in patients who did not have a steroid-related aetiology [7] .…”

Cartilage restoration of the hip using fresh osteochondral allograft

“…We have previously reported on the results of eight of the patients included in the present study. 29 We concluded in this earlier study, that the patient with intractable post-allograft pain and progressive degenerative changes, who ultimately went on to conversion to THR six months after allograft, was a poor candidate for osteochondral allograft because of her longterm steroid use. We suggested at the time that steroidinduced AVN may predispose a patient to failure with an osteochondral allograft as the host bone may not be amenable to graft osteointegration due to diffuse metabolic damage, subchondral bone sclerosis and compromised vascularity.…”