Abstract
Morphological abnormalities such as cam deformity or growth disturbances can have a detrimental effect on the smooth function of the hip joint. This case reports an attempt to salvage the hip joint of a young patient with a posttraumatic growth disturbance of the femoral head using a fresh osteochondral allograft. This treatment has been used very rarely in the femoral head due to the presumed tenuous blood supply of the head and the perceived risk of nonunion or progressive avascular necrosis. The patient in this case had persistent pain and mechanical symptoms leading to hip replacement. A detailed analysis of the retrieved femoral head demonstrated durability and healing of the grafts based on gross inspection, histology of bone and cartilage, and microCT analysis. This case is the first report to our knowledge of a detailed histological and radiographic analysis of the fate of osteochondral allografts of the femoral head. We hope that this case provides justification for the use of osteochondral allografts of the femoral head for other indications such as femoral head fractures, avascular necrosis, and benign epiphyseal tumors of the femoral head in an effort to avoid arthroplasty in young patients. The authors have obtained the patient's informed written consent for print and electronic publication of the case report.
Highlights
Morphological abnormalities such as cam deformity or growth disturbances can have a detrimental effect on the smooth function of the hip joint
The objective of this report is to demonstrate based on histology and advanced imaging that osteochondral allografting is an appropriate and advantageous treatment in cases of structural abnormalities of the femoral head from trauma, avascular necrosis, or osteoarthritis
The femoral head has been viewed by some as a “no man’s land” for cartilage treatment. This has largely been a result of the lack of access to the femoral head due to its tenuous blood supply [3, 4]
Summary
A 22-year-old male was examined for a chief complaint of left hip pain. He had sustained a left femoral shaft fracture, treated with a locked intramedullary nail placed through a trochanteric start point at the age of 13. A 3D CT scan was obtained, and reconstructions were generated This demonstrated a global absence of bone on the lateral aspect of the femoral head. Due to his age and absence of osteoarthritis, surgical hip dislocation and osteochondral allografting of the femoral head were recommended in order to address the area of lateral femoral head hypoplasia. The area of lateral femoral head hypoplasia was immediately proximal to the MFCA (Figure 2(a)) with three grafts being placed proximal to the entry site of the MFCA into bone. A total of 3 grafts were placed in the lateral femoral head and interlocked in a “snowman” configuration such that the edge of the peripheral grafts was removed to accommodate the central most graft (Figure 2(b)) These were implanted using a widely used commercially available transplantation set (Allograft OATS, Arthrex, Naples, FL, USA). The capsule was repaired followed by the repair of the trochanteric osteotomy with a total of three 3.5 mm cortical screws (Synthes, Paoli, PA, USA)
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