Do Femoral Head Osteochondral Lesions Predict a Poor Outcome in Hip Arthroscopy Patients? A Matched Control Study With Minimum 5-Year Follow-Up

Ashberg, Lyall; Close, Mary R.; Perets, Itay; Chaharbakhshi, Edwin O.; Walsh, John P.; Mohr, Mitchell R.; Domb, Benjamin G.

doi:10.1016/j.arthro.2018.08.053

Cited by 23 publications

(25 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In patients undergoing hip arthroscopy, the impact of femoral head lesions has been shown to be detrimental, with lower outcome scores and greater rates of conversion to total hip arthroplasty. 2,8 Current treatment options are limited and are technically demanding even for an experienced surgeon. Arthroscopic osteochondral transplantation had been described for chondral lesions at the femoral head, but its use is limited to smaller lesions along the anterosuperior and anterolateral aspects of the femoral head, due to visualization constraints.…”

Section: Pearls Pitfallsmentioning

confidence: 99%

Osteochondral Allograft Implantation Using the Smith–Peterson (Anterior) Approach for Chondral Lesions of the Femoral Head

Chen

Rosinsky

Shapira

et al. 2020

Arthroscopy Techniques

Self Cite

View full text Add to dashboard Cite

Management of chondral lesions of the femoral head can be challenging. Previously described approaches include arthroscopic surgery for small lesions and open surgical dislocation for larger lesions. In 2001, Ganz popularized the trochanteric flip osteotomy for surgical dislocation, and this remains the workhorse for treatment of large chondral lesions. However, by using a SmithePeterson (direct anterior) approach and a femoral head allograft, large lesions may be treated while avoiding both trochanteric osteotomy and donor-site morbidity. We present our technique using a SmithePeterson approach and osteochondral implantation of fresh femoral head allograft for surgical treatment of a femoral head chondral lesion. C hondral lesions of the femoral head are less common than lesions of the acetabulum; however, they are still commonly encountered in patients undergoing hip arthroscopy. 1,2 Chondral defects may be caused by trauma, femoroacetabular impingement, avascular necrosis, osteochondral lesion, or as a late sequela of LeggeCalveePerthes disease. These lesions can cause significant pain and mechanical symptoms, and may result in joint incongruency that can contribute to the development of secondary arthritis. 3 Although first-line management is typically conservative with activity modification, anti-inflammatory medications, and physical therapy, failure of this regiment is an indication for surgical treatment. Surgical

show abstract

Section: Pearls Pitfallsmentioning

confidence: 99%

Osteochondral Allograft Implantation Using the Smith–Peterson (Anterior) Approach for Chondral Lesions of the Femoral Head

Chen

Rosinsky

Shapira

et al. 2020

Arthroscopy Techniques

Self Cite

View full text Add to dashboard Cite

show abstract

“…With partly cartilage defect, the function of hip was still well. Femoral head with part chondral lesion detected during arthroscopic surgery still functioned well with minimum 5 years follow-up [34] . These findings indicate that mechanical failure, rather than cartilage degeneration, is the main cause of pain.…”

Section: Discussionmentioning

confidence: 89%

“…Partly defect of joint cartilage does not associated with poor clinical results [32,33] . In a minimum 5 years follow-up, femoral head with chondral lesion does not portend a worse clinical outcome [34] . All of these findings indicate that mechanical failure, rather than cartilage degeneration, is the main cause of symptom in ONFH without arthritis.…”

Section: Introductionmentioning

confidence: 93%

Modified trapdoor procedures using autogenous tricortical iliac graft without preserving the broken cartilage to treat osteonecrosis of the femoral head: A Prospective Cohort Study With Historical Controls

Cheng

zhao

et al. 2020

Preprint

View full text Add to dashboard Cite

Background The aim of the present study was to investigate clinical and radiological outcomes of autologous tricortical iliac graft through a window created at the femoral head, without suturing the opened articular cartilage to treat osteonecrosis of the femoral head (ONFH), called modified trapdoor procedures.Methods A total of 59 consecutive patients (67 hips; 36 males and 23 females) with ONFH were included in this study, which was conducted during the period from April 2009 to March 2012. Patient age ranged from 27 to 46 years old, with mean age of 36.3 years. Harris hip scores (HHS) were used to evaluate hip function pre- and postoperatively. Anteroposterior and frog-position X-rays and magnetic resonance imaging (MRI) were conducted to evaluate lesion location, size, and ARCO stage. Clinical failure was defined as score < 80 points or treatment by total hip arthroplasty(THA). Radiographic failure was defined as a > 3 mm of collapse in the hip. This group was retrospectively matched according to the ARCO stage, extent, location, etiology of the lesion, average age, gender, and preoperative Harris hip score to a group of 59 patients (67 hips) who underwent the“light bulb”approach during March 2007 to April 2009. Results Mean follow-up was 91.2 ± 13.6 months (range, 75–115 months). Mean HHS was 91.3 ± 4.5, compared with 83.1± 4.5 in the “light bulb” cohort at the 6 years follow-up examination (P < 0.001). At the 6 years follow-up, for modified trapdoor procedures, five hips (8.5%) were classified as clinical failure, and 3 hips underwent total hip arthroplasty; Seven hips were classified as (10.4%) radiographic failure.The clinical and radiographic failure of the hips treated with the modified trapdoor procedure was significantly lower than that of the hips treated with the “light bulb” procedure (p < 0.05). Survival of the joint was not significantly related to the location of the femoral head lesion between two groups, but there was better clinical and radiographic results in modified trapdoor procedures with Size-C and the ARCO stage III.Conclusion The study demonstrated superior medterm clinical results in ONFH with the use of autologous tricortical iliac block graft through a femoral head window, without suturing the opened articular cartilage. The results of this femoral head-preserving procedure in patients with postcollapse osteonecrosis and large lesion are superior to those of the “light bulb” procedure treatment.

show abstract

“…The first advantage of our technique, compared with the traditional trapdoor procedure, was that a tricortical iliac block graft fixed with one or two screws can more easily heal with host bone and provide good structural support [18,32] . The autogenous iliac crest transplantation is an effective treatment.…”

Section: Discussionmentioning

confidence: 99%

“…More and more studies showed that if the mechanical was stable, the hips could maintain no symptom or a slight discomfort. Partly defect of joint cartilage does not associated with poor clinical results [32,33] . In a minimum 5 years follow-up, femoral head with chondral lesion does not portend a worse clinical outcome [34] .…”

Section: Introductionmentioning

confidence: 94%

Modified trapdoor procedures using autogenous tricortical iliac graft without preserving the broken cartilage to treat osteonecrosis of the femoral head: A Prospective Cohort Study With Historical Controls

Cheng

zhao

et al. 2019

Preprint

View full text Add to dashboard Cite

Background The aim of the present study was to investigate clinical and radiological outcomes of autologous tricortical iliac graft through a window created at the femoral head, without suturing the opened articular cartilage to treat osteonecrosis of the femoral head (ONFH), called modified trapdoor procedures. Methods A total of 59 consecutive patients (67 hips ) with ONFH were included in this study, which was conducted during the period from April 2009 to March 2012. Harris hip scores (HHS) were used to evaluate hip function pre- and postoperatively. Anteroposterior and frog-position X-rays and magnetic resonance imaging (MRI) were conducted to evaluate lesion location, size, and ARCO stage. Clinical failure was defined as score < 80 points or treatment by total hip arthroplasty(THA). Radiographic failure was defined as a > 3 mm of collapse in the hip. This group was retrospectively matched according to the ARCO stage, extent, location, etiology of the lesion, average age, gender, and preoperative Harris hip score to a group of 59 patients (67 hips) who underwent the“light bulb”approach during March 2007 to April 2009. Results Mean follow-up was 91.2 ± 13.6 months (range, 75–115 months). Mean HHS was 91.3 ± 4.5, compared with 83.1± 4.5 in the “light bulb” cohort at the 6 years follow-up examination ( P < 0.001). At the 6 years follow-up, for modified trapdoor procedures, five hips (8.5%) were classified as clinical failure, and 3 hips underwent total hip arthroplasty; Seven hips were classified as (10.4%) radiographic failure.The clinical and radiographic failure of the hips treated with the modified trapdoor procedure was significantly lower than that of the hips treated with the “light bulb” procedure (p < 0.05). Survival of the joint was not significantly related to the location of the femoral head lesion between two groups, but there was better clinical and radiographic results in modified trapdoor procedures with Size-C and the ARCO stage III. Conclusion The study demonstrated superior medterm clinical results in ONFH with the use of autologous tricortical iliac block graft through a femoral head window, without suturing the opened articular cartilage.

show abstract

Do Femoral Head Osteochondral Lesions Predict a Poor Outcome in Hip Arthroscopy Patients? A Matched Control Study With Minimum 5-Year Follow-Up

Cited by 23 publications

References 25 publications

Osteochondral Allograft Implantation Using the Smith–Peterson (Anterior) Approach for Chondral Lesions of the Femoral Head

Osteochondral Allograft Implantation Using the Smith–Peterson (Anterior) Approach for Chondral Lesions of the Femoral Head

Modified trapdoor procedures using autogenous tricortical iliac graft without preserving the broken cartilage to treat osteonecrosis of the femoral head: A Prospective Cohort Study With Historical Controls

Modified trapdoor procedures using autogenous tricortical iliac graft without preserving the broken cartilage to treat osteonecrosis of the femoral head: A Prospective Cohort Study With Historical Controls

Contact Info

Product

Resources

About