Osteochondral Allograft Transplantation of the Femoral Head via Surgical Hip Dislocation: Survivorship and Patient Reported Outcome Measures at Minimum 2-Year Follow-Up.
Academic Article
Overview
abstract
BACKGROUND: Treatment of isolated osteochondral lesions of the femoral head in young patients presents a clinical challenge for orthopaedic surgeons. Nonoperative management is associated with poor patient satisfaction and the development of osteoarthritis, while arthroplasty in young patients raises concerns regarding implant longevity. PURPOSE: To evaluate patient-reported outcome measures (PROMs) and the rate of conversion to THA after osteochondral allograft (OCA) transplantation via surgical hip dislocation (SHD) for isolated cartilage lesions of the femoral head. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Patients who underwent femoral head OCA via SHD at our institution between August 2010 and June 2023, with a minimum 2-year follow-up, were retrospectively reviewed. Demographic, perioperative, and complication data were collected prospectively from a registry. The Modified Harris Hip Score (mHHS) and the International Hip Outcome Tool-12 (iHOT-12) were administered pre- and postoperatively. The minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) thresholds established for hip arthroscopy in patients with femoroacetabular impingement were used to assess patient outcomes. RESULTS: A total of 24 patients (54% women; mean age, 22.4 years) were included. The mean lesion size was 488 mm2, and the mean OCA graft depth was 8.8 mm. At a mean follow-up of 47.9 months, mHHS scores improved from 62.1 preoperatively to 83.9 postoperatively (P < .001), and iHOT-12 scores improved from 35.5 preoperatively to 77.5 postoperatively (P < .001). The MCID was achieved by 67% and 76% of patients for the mHHS and the iHOT-12, respectively. The PASS was completed by 62% and 67% of patients for the mHHS and the iHOT-12, respectively. Two patients (8.3%) required subsequent hip arthroscopy, and 6 patients (25%) required conversion to hip arthroplasty at a mean of 3.8 years postoperatively (range, 0.75-10.3 years). Patients requiring conversion to THA demonstrated an increased OCA graft depth (P = .03) compared with those who did not require conversion to THA. CONCLUSION: Treatment of femoral head osteochondral lesions with OCA via SHD was associated with significant postoperative improvements in PROMs, with a 25% rate of conversion to hip arthroplasty, at a mean follow-up of 4 years. Increased OCA graft depth was associated with conversion to THA. OCA transplantation provides a versatile treatment option for isolated femoral head osteochondral lesions in young patients.
