FP5.7 Clinical Outcomes following Osteochondral Allograft Transplantation of the Femoral Head via Surgical Hip Dislocation

Background: Treatment of isolated osteochondral loss of the femoral head in young, active patients presents a clinical challenge for orthopedic surgeons. Non-operative management is often associated with poor patient satisfaction and may lead to rapid development of osteoarthritis. Additionally, hip arthroplasty in young patients are associated with concerns regarding implant longevity. The purpose of this study was to evaluate clinical and patient reported outcome measures (PROMs) following osteochondral allograft (OCA) transplantation via surgical hip dislocation (SHD) for isolated cartilage lesions of the femoral head in young patients.

Methods: All patients in our institution’s hip preservation group who underwent OCA of the femoral head via SHD between August 2010 and June 2023 were retrospectively reviewed. Demographic and perioperative data were collected and need for subsequent surgery was recorded at most recent follow-up. Modified Harris Hip Score (mHHS) and International Hip Outcome Tool 12 (iHOT-12) were collected pre-operatively and post-operatively. Minimal clinically important difference (MCID) thresholds for hip arthroscopy were used to assess patient outcomes.

Results: Twenty-nine patients (51.7% female; mean age 21.6 years) were included. Pre-operative diagnoses included developmental dysplasia (n=9, 31.0%), post-traumatic (n=9, 31.0%), femoroacetabular impingement (n=5, 17.2%), Legg-Calvé-Perthes disease (n=3, 10.3%), avascular necrosis (n=2, 6.9%), and chondroblastoma (n=1, 3.5%). Mean lesion size was mm 418 (range: 154-972 mm) and mean OCA graft depth was 8.5 mm (range: 6-16 mm). Fourteen patients (48.3%) had a history of prior ipsilateral hip surgery. At a mean 41.5-month (range: 5.8–126.0 month) follow-up, mHHS improved from 58.5 to 84.1 (p<.001), and iHOT-12 improved from 34.7 to 77.9 (p<.001). MCID was achieved in 84% of patients for both mHHS and iHOT-12. Four patients (13.7%) required conversion to hip arthroplasty (3 total hip arthroplasties, 1 hip resurfacing) at an average of 2.5 years following OCA via SHD.

Conclusions: Treatment of osteochondral lesions with OCA via SHD was associated with significant post-operative improvements in PROMs, and the rate of conversion to hip arthroplasty at average follow up of nearly 4 years was relatively low in our cohort. Osteochondral allograft transplantation may provide a safe, versatile surgical option for treating isolated femoral head chondral lesions in young patients.