Hip preservation for large femoral head articular cartilage defects and irreparable acetabular labral deficiency using fresh osteochondral allograft transplantation and fresh meniscus allograft transplantation

Abstract

Introduction:

Avascular necrosis (AVN), chondrolysis, and or trauma to the femoral head with acetabular labrum involvement leads to predictable end-stage osteoarthritis of the hip. A hip preservation procedure that restores articular integrity and delays osteoarthritis is needed. Osteochondral allograft transplantation (OCAT) is a potential solution but may fail if other intra-articular pathology is not addressed. We describe our detailed surgical technique that addresses femoral head osteochondral lesions and irreparable acetabular labral pathology, through OCAT and fresh meniscus allograft transplantation (MAT) as a follow-up to our previously published clinical series.

Materials and methods:

The surgical technique described is to address femoral head article cartilage defects >2 cm² (grade III or IV). Via open surgical hip dislocation, fresh OCAT was used to address the femoral head articular cartilage defects and fresh MAT was used for irreparable acetabular labral deficiency. Femoral head OCAT was performed using either cylindrical grafts or custom-cut patient-specific shell grafts preserved with the Missouri Osteochondral Preservation System (MOPS). For acetabular labral reconstruction, standard recipient site preparation was performed. MOPS-preserved medial or lateral meniscus allografts were used based on the recipient labrum’s radius of curvature. Suture anchor fixation was used to secure the graft. Labral allograft fixation was performed with the hip reduced from anterior to posterior using the preplaced knotless anchors. A posterior junctional suture was used to fix the graft to the native labrum.

Conclusions:

A surgical technique combining fresh OCAT and fresh MAT is presented to provide a hip preservation surgery option that addresses femoral head and acetabular labrum pathology to minimise the risk of disease progression.