Femoral head osteochondral allograft transplantation with and without simultaneous periacetabular osteotomy: a case series

TL;DR

This case series explores the outcomes of femoral head osteochondral allograft transplantation, showing it may delay the need for hip replacement surgery.

Contribution

The study presents clinical outcomes of femoral head osteochondral allograft transplantation with and without periacetabular osteotomy in a small patient cohort.

Findings

Patients returned to weight bearing in 9.8 weeks and physical activities in 9.9 months on average.

Five patients showed significant improvement in physical function PROMIS scores.

One patient required THA six years post-surgery, while others had sustained pain reduction and functional gains.

Abstract

Focal femoral head degeneration can lead to loss of structural support of the femoral head and eventual collapse. Formerly, total hip arthroplasty (THA) was the only definitive means available to restore function and mitigate pain. Osteochondral allograft transplantation (OATS) of the femoral head can be used to potentially prevent or delay THA, and the aim of this study is to analyse outcomes of patients who have undergone OATS procedures. An OATS procedure involves vessel-sparing hip dislocation to achieve global femoral head exposure, removal of damaged cartilage and subchondral bone, and press-fit implantation of a fresh femoral head allograft. Eleven patients have undergone OATS at our institution, and we collected retrospective data and Patient-Reported Outcome Measurement Information System (PROMIS) data. All eleven patients demonstrated focal femoral head degeneration. Six patients underwent simultaneous PAO for concomitant structural instability. Postoperatively, patients returned to weight bearing by an average of 9.8 ± 5.6 weeks and physical activities in 9.9 ± 2.9 months. Four patients had unrelated health conditions limiting physical activity involvement. One patient had undergone THA, 6 years postoperatively. Five patients provided updated follow-up metrics, demonstrating significant improvement in average physical function PROMIS scores (P = .01). Patients in our series demonstrated sustained favourable outcomes for pain reduction and functional gain at the time of their final follow up. The femoral head OATS procedure may be a reliable treatment with potential to delay THA. In patients with concomitant dysplasia, combined OATS and PAO may provide further enhancement and durability of surgical outcomes.

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