Knee Joint Osteochondral Reconstruction Using Fresh Femoral Head Autograft

Abstract

We present the management of polyarticular osteonecrosis in a 17-year-old female, with marked symptoms involving both hips and one knee. As a complication of chemotherapy to treat leukaemia, the articular surfaces of both femoral heads and the right knee lateral femoral condyle collapsed, resulting in significant pain and disability. For this unusual case a novel technique was employed, using a method we believe has not been described previously. The articular surface of the knee was reconstructed using fresh bulk osteochondral autograft harvested from the ipsilateral femoral head during a simultaneous total hip arthroplasty. Reconstructive options in young patients with multiple joints involved are often restricted, and suitable osteochondral allografts can be difficult to obtain. Fresh osteochondral auto-grafting enabled rapid osseous integration and articular surface reconstruction using living host cartilage, resulting in an excellent clinical outcome. Although uncommon, concurrent avascular necrosis of multiple large joints is occasionally encountered, and management options are particularly limited in young patients. We recommend this innovative technique be considered in those patients who satisfy the criteria for bulk osteochondral grafting procedures where total hip replacement is also required.