ePoster #1104 - ISHA Annual Scientific Meeting 2016
Outcomes of Osteochnodral Grafting of the Hip
Andrea Spiker, MD, New York, NY UNITED STATES
Mollyann Pais, BS, New York, NY UNITED STATES
Riley Williams, MD, New York, New York UNITED STATES
Anil Ranawat, MD, New York, NY UNITED STATES
Ernest Loumaine Sink, MD, New York, NY UNITED STATES
Bryan Talmadge Kelly, MD, New York, NY UNITED STATES
Hospital for Special Surgery, New York, New York, UNITED STATES
FDA Status Not Applicable
Summary: We report on a series of patients who underwent osteochondral grafting of the acetabulum or femoral head and discuss their patient reported outcomes.
Introduction: Treatment of isolated osteochondral lesions of the acetabulum or femoral head are a challenge. Non-operative management often leads to poor patient satisfaction and can lead to progression of osteoarthritis, which can be devastating for young, active patients. Total hip arthroplasty is a reliable option to relieve osteoarthritic pain and restore function, but is not the ideal initial procedure for young and active patients. Various surgical techniques have been described in case reports and limited case series, including microfracture, autologous chondrocyte implantation, mosaicplasty and osteochondral allograft, but no gold standard operation has been established for this difficult problem. We present our case series of patients who have had osteochondral grafting of isolated cartilage lesions of the hip and discuss their post-surgical patient reported outcomes.
Methods: We identified all patients in our institution’s preservation group who underwent osteochondral grafting of the hip (intra-articular acetabular or femoral head osteochondral lesions). We reviewed patient records and imaging to classify etiology and location of the osteochondral defect and detailed the surgical treatment. Through our hip registry we analyzed the patients’ pre- and post-operative patient reported outcome scores, including the modified Harris Hip Score (mHHS), Hip Outcome Score-Activities of Daily Living and -Sport Specific (HOS-ADL and HOS-SS).
Results: 15 patients underwent osteochondral grafting of the hip for isolated osteochondral defects. The average age of our patients was 29.4 years. 10 patients had an osteochondral allograft (OCA) and 5 underwent grafting with an osteochondral autograft. The average pre-operative outcomes scores were mHHS 57.5, HOS-ADL 65.6, and HOS-SS 45.1. For those who had osteochondral allograft, the pre-op mHHS was 57.3, HOS-ADL 63.9, HOS-SS 43.7; 6 months post op sores were mHHS 79.6, HOS-ADL 86.5, HOS-SS 65. 2 year follow up scores were mHHS 82.9, HOS-ADL 91.5, HOS-SS 75.6. For the patients who had an osteochondral allograft, average pre-operative scores were mHHS 58.3, HOS-ADL 72.9, HOS-SS 51.4. Average 1 year scores were mHHS 87.5, HOS-ADL 95.6, HOS-SS 88.6.
Discussion: Treatment of isolated osteochondral acetabular or femoral head defects in young, active patients is a challenge. Of the surgical treatments that offer hip preservation, microfracture may offer good results for small lesions, but does not allow for hyaline cartilage restoration and thus likely limits long term viability. Autologous chondrocyte implantation is only an option in full thickness cartilage lesions which have an intact subchondral plate, and long term outcomes in the literature are limited. Mosaicplasty and osteochondral allograft grafting require a significant surgery consisting of surgical hip dislocation, and in the case of mosaicplasty/OATS, autograft harvesting. However, based on our case series, we found that mosaicplasty and osteochondral allografts in treating this difficult problem result in good patient reported outcomes.