Promising outcomes of hip mosaicplasty by minimally invasive anterior approach using osteochondral autografts from the ipsilateral femoral head

PURPOSE

Recent studies demonstrated promising results of mosaicplasty for femoral head osteochondral lesions using posterior and lateral approaches. This study aimed to evaluate outcomes of mosaicplasty using ipsilateral femoral head autografts by minimally invasive anterior approach. The hypothesis was that this surgical technique would grant satisfactory clinical outcomes with considerable improvement of clinical scores.

METHODS

A consecutive series of 27 mosaicplasties, to treat osteochondral lesions of the femoral head measuring 1.6 ± 0.7 cm² (range 0.8-4.0) in patients aged 28.7 ± 7.4 years (range 19-44), was evaluated using the mHHS and WOMAC scores at minimum follow-up of 12 months. All patients were operated by minimally invasive anterior (Hueter) approach and osteochondral plugs were harvested from the non-weight-bearing portion of the femoral head. Adjuvant osteoplasty was necessary for some patients at the acetabulum (n = 3), femur (n = 14) or both (n = 2).

RESULTS

Three patients were excluded due to concomitant periacetabular osteotomies or shelf procedures, one patient could not be reached, and another was revised to THA. This left 22 patients for clinical assessment at 39.4 ± 23.2 months (12.0-90.2). Their mHHS improved from 56.3 ± 12.6 to 88.4 ± 9.9, and WOMAC improved from 45.1 ± 16.9 to 80.6 ± 13.0. Two patients (8.4%) underwent arthroscopy at 13 and 30 months to remove painful residual cam-type deformities. Regression analyses revealed that net improvement in WOMAC decreased with lesion size (p = 0.002) and increased with follow-up (p = 0.004).

CONCLUSIONS

Hip mosaicplasty using autografts from the ipsilateral femoral head, performed by minimally invasive anterior approach, granted satisfactory outcomes and functional improvements. Caution is, however, advised for lesions > 2 cm² (diameter > 16 mm) which may be a threshold limit for this procedure.

LEVEL OF EVIDENCE

Level IV, Case series.

[Arthroscopic-assisted mini-open technique for the treatment of femoroacetabular impingement : Video article]

INTRODUCTION

Femoroacetabular impingement of the hip is considered a prearthrotic deformity, which should be treated at an early state to prevent complications.

MATERIAL

This video demonstrates the arthroscopic-assisted mini-open technique for the treatment of femoroacetabular impingement of the hip. In the case presented a combined Pincer and Cam-deformity is treated with rim trimming, translabral labral refixation with two suture anchors and reconstruction of the head-neck junction.

CONCLUSION

The arthroscopic-assisted mini-open technique is a safe and reproducible procedure for treatment of femoroacetabular impingement. It provides an alternative to hip arthroscopy and an additional treatment option in the portfolio of hip surgeons.

Ten-year results of concentrated autologous bone marrow aspirate transplantation for osteonecrosis of the femoral head: a retrospective study

BACKGROUND

Idiopathic osteonecrosis of the femoral head (ONFH) occurs at a relatively younger age. It is therefore important to prevent the resultant femoral head collapse and requirement of total hip arthroplasty in these patients. In 2003, we initiated concentrated autologous bone marrow aspirate transplantation (CABMAT), a joint-preserving treatment for ONFH, at our institution. Here, we report the long-term results of CABMAT treatment.

METHODS

We retrospectively collated and analyzed the demographic and treatment data of 69 patients (109 hips) with idiopathic ONFH treated with CABMAT between April 2003 and April 2008.

RESULTS

Totally, 44 patients (21 men, 23 women, 80 hips) completed the 10-year follow-up. The follow-up rate was 73.4%, and the mean follow-up period was 12.0 (range, 10.0-15.4) years. The mean age of the patients was 42.2 (range, 16.3-70.5) years. Using the Association Research Circulation Osseous (ARCO) classification system for preoperative analysis, 12, 31, 32, and 5 hips were classified as stages 1, 2, 3, and 4, respectively. The overall rate of conversion to total hip arthroplasty (THA) was 34% (27/80 hips). In a multivariate regression analysis, the preoperative stage of ONFH and the body mass index were found to correlate significantly with conversion to THA. Totally, 43 hips (of 80) were classified as belonging to the pre-collapse stage (i.e., stages 1 or 2). The overall collapse rate and the THA-conversion rate of these hips were estimated to be 49% (21/43) and 14% (6/43), respectively.

CONCLUSIONS

On the basis of our long-term findings, the minimally invasive and feasible CABMAT therapy can be utilized as one of a joint-preserving treatment for ONFH.