Ipsilateral femoral head osteochondral transfers for osteochondral defects of the femoral head

Abstract

Osteochondral defects of the femoral head are rare. Several treatment options have been described, though there is currently no consensus on the appropriate management of these lesions. Five patients underwent femoral head osteochondral autograft transfer for treatment of ipsilateral femoral head osteochondral defects via surgical hip dislocation between 2011 and 2014 at our institution. The mean age of the patients was 24.8 (16-37) years. There were four females and one male. Mean follow-up was 53.8 (30-64) months. Four patients reported complete resolution of preoperative pain, return to baseline activities and were satisfied with their results. Harris hip scores improved from a mean 60.8 (30-87) to 86.6 (44-100). There was no radiographic evidence of progression of the femoral head defects. There were no operative complications. Osteochondral autograft transfer from the ipsilateral femoral head using a surgical hip dislocation demonstrated good clinical and radiographic outcomes at midterm follow-up in our cohort and may be considered a suitable option for management of these lesions in select patients. Further research and follow-up is warranted to more clearly define the indications and outcomes of this procedure.

Fig. 1.

Preoperative imaging. Anteroposterior X-ray view of the pelvis (A) and frog leg lateral view of the right hip (B) of a 25-year-old woman who presented with right hip pain. Her past medical history included nephrotic syndrome which required intermittent treatment with high dose corticosteroids. One year prior to her presentation, she was treated with a core decompression at an outside institution for osteonecrosis of the femoral head which is evident on her X-rays. However, she continued to have pain. Coronal (C) and sagittal (D) magnetic resonance images further characterized the osteochondral lesion with collapse that involved a large area of the weightbearing portion of the femoral head.

Fig. 2.

Intraoperative pictures. (A) The osteochondral lesion is visualized with collapse. Note the donor site trochar is placed at the inferomedial aspect of the femoral head to harvest an osteochondral autograft plug. (B) The donor site is seen with the osteochondral autograft removed. (C) After the osteochondral defect area was prepared with a trochar, the osteochondral autograft was transferred to the recipient site and stabilized with a press-fit technique. (D) A trochar is used to remove autograft cancellous bone to place at the donor site along the inferomedial portion of the femoral head.

Fig. 3.

Postoperative imaging. Anteroposterior view of the pelvis (A), anteroposterior X-ray of the right hip (B) as well as frog-leg (C) and cross-table (D) lateral X-rays of the right hip at 5 years of follow-up. She continues to be pain-free with her right hip and is satisfied with the procedure. Note preservation of her femoral head as a sphere and maintenance of her joint space without degenerative changes.