Fresh Osteochondral Allograft Transplantation for Treatment of Chondroblastoma of the Femoral Head: A Case Report.

Abstract

In 1908, Erich Lexer reported the use of donor tissue from freshly amputated limbs for use in joint replacement1. Fresh allograft utilization increased in the 1970s, and fresh allografts have been successfully used in treating articular cartilage defects in the knee, ankle, hip, and shoulder2-9. Although frozen osteoarticular allografts are commonly used in limb salvage surgical procedures in musculoskeletal oncology, fresh allografts are rarely used. Chondroblastoma is a rare tumor that accounts for approximately 1% to 2% of all benign bone tumors10-14. Patients with chondroblastoma have pain and limitation of joint movement11-14. Imaging studies show lytic epiphyseal lesions with a sclerotic margin11,15. Treatment usually involves curettage and packing of the defect with bone graft11,12,14. We present a thirty-four-year-old man who underwent fresh osteochondral allografting after removal of a chondroblastoma that had caused articular cartilage and subchondral bone collapse in the weight-bearing portion of the femoral head. The patient was informed that data concerning the case would be presented for publication, and he provided consent. A thirty-four-year-old man presented with a two-year history of pain in the left side of the groin with walking, which was exacerbated with abduction and external rotation of the hip. Physical examination demonstrated full passive hip motion equivalent to the contralateral hip, with pain at the extremes of abduction and external rotation. The preoperative Harris hip score was 86. Radiographs showed a lytic epiphyseal lesion in the femoral head (Fig. 1). Magnetic resonance imaging (MRI) demonstrated edema surrounding the lesion, with irregularity of the overlying articular cartilage in the weight-bearing portion of the femoral head (Fig. 2). Fig. 1 Preoperative anteroposterior radiograph with a well-defined epiphyseal lesion with sclerotic margins, which are findings …