Subchondral drilling for chondral flaps reduces the risk of total hip arthroplasty in femoroacetabular impingement surgery at minimum five years follow-up

Haefeli, Pascal C; Tannast, Moritz; Beck, Martín; Siebenrock, Klaus A.; Büchler, Lorenz

doi:10.1177/1120700018781807

Cited by 5 publications

(5 citation statements)

References 34 publications

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“…The current study adds to the growing body of literature regarding treatment strategies for full-thickness chondral flaps. Haefeli et al 16 found that subchondral drilling under the chondral flap decreased the rate of conversion to THA when compared with simple debridement of the chondral flap. Similarly, Hevesi et al 19 compared microfracture and debridement and reported mHHS, HOS-Sport, and VAS improvements that were similar to those of the microfracture cohort in our study.…”

Section: Discussionmentioning

confidence: 99%

Treatment of Full-Thickness Acetabular Chondral Flaps During Hip Arthroscopy: Bone Marrow Aspirate Concentrate Versus Microfracture

Kucharik

Abraham

Nazal

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: The optimal treatment strategy for patients with full-thickness chondral flaps undergoing hip arthroscopy is controversial. Purpose: To compare functional outcomes of patients who underwent bone marrow aspirate concentrate (BMAC) application with those of patients who underwent microfracture. Study Design: Cohort study; Level of evidence, 3. Methods: This was a retrospective case series of prospectively collected data on patients who underwent arthroscopic acetabular labral repair by 1 surgeon between June 2014 and April 2020. The inclusion criteria for this study were age ≥18 years, preoperative radiographs of the pelvis, arthroscopic acetabular labral repair, exposed subchondral bone with overlying chondral flap seen at the time of hip arthroscopy, microfracture or BMAC to address this lesion, and completed patient-reported outcome measures (PROMs) (International Hip Outcome Tool–33 [iHOT-33], Hip Outcome Score–Activities of Daily Living [HOS-ADL], Hip Outcome Score–Sports Subscale [HOS-Sport], modified Harris Hip Score [mHHS], and visual analog scale [VAS] for pain) at enrollment and 12-month follow-up. Clinical outcomes were assessed using PROM scores. Results: A total of 81 hips with full-thickness chondral flaps were included in this study: 50 treated with BMAC and 31 treated with microfracture. There were no significant differences between groups in age, sex, body mass index, tear size, radiographic osteoarthritis, or radiographic femoroacetabular impingement. In the BMAC cohort, all PROM scores improved significantly from preoperatively to follow-up: 41.7 to 75.6 for iHOT-33, 67.6 to 91.0 for HOS-ADL, 41.5 to 72.3 for HOS-Sport, 59.4 to 87.2 for mHHS, and 6.2 to 2.2 for VAS pain ( P < .001 for all). In the microfracture cohort, the score improvements were 48.0 to 65.1 for iHOT-33 ( P = .001), 80.5 to 83.3 for HOS-ADL ( P = .275), 59.2 to 62.4 for HOS-Sport ( P = .568), 70.4 to 78.3 for mHHS ( P = .028), and 4.9 to 3.6 for VAS pain ( P = .036). Regarding clinically meaningful outcomes, 77.6% of the BMAC group and 50.0% of the microfracture group met the minimal clinically important difference for iHOT-33 at the 12-month follow-up ( P = .013). Conclusion: Patients with full-thickness chondral flaps at the time of hip arthroscopy experienced greater improvements in functional outcome scores at the 12-month follow-up when treated with BMAC as opposed to microfracture.

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Section: Discussionmentioning

confidence: 99%

Treatment of Full-Thickness Acetabular Chondral Flaps During Hip Arthroscopy: Bone Marrow Aspirate Concentrate Versus Microfracture

Kucharik

Abraham

Nazal

et al. 2021

Orthopaedic Journal of Sports Medicine

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“…21 Size of the cartilage flaps and distribution of cartilage lesions was comparable between the 2 groups and was calculated according to a previously described method ( Table 1 ). 13 At the time of surgery, there was no evidence defining the optimal treatment of acetabular cartilage flaps. Institutional standard treatment at that time was either minimal debridement of the cartilage flap and additional subchondral drilling of the delaminated area (study group) or retaining the cartilage flap with minimal debridement and no further treatment (control group).…”

Section: Methodsmentioning

confidence: 99%

“…Despite that, the clinical scores and the progression of osteoarthritis on conventional radiographs in the remaining patients with a preserved hip did not differ. 13 There are however obvious limitations of conventional radiography in detecting focal changes of cartilage quality. Magnetic resonance imaging (MRI) is more sensitive in detecting subtle morphologic patterns of early joint degeneration secondary to FAI using semiquantitative scores.…”

Section: Introductionmentioning

confidence: 99%

Improved Cartilage Quality on Delayed Gadolinium-Enhanced MRI of Hip Cartilage after Subchondral Drilling of Acetabular Cartilage Flaps in Femoroacetabular Impingement Surgery at Minimum 5-Year Follow-Up

et al. 2020

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Objective To assess whether subchondral drilling of acetabular cartilage flaps during femoroacetabular impingement (FAI) surgery improves (1) acetabular dGEMRIC indices and (2) morphologic magnetic resonance imaging (MRI) scores, compared with hips in which no additional treatment of cartilage lesions had been performed; and (3) whether global dGEMRIC indices and MRI scores correlate. Design Prospective cohort study of consecutive patients with symptomatic FAI treated with open surgery between 2000 and 2007. Patients with subchondral drilling of acetabular cartilage flaps were allocated to the study group, those without drilling to the control group. All patients underwent indirect 3-T MR arthrography to assess cartilage quality by dGEMRIC indices and a semiquantitative morphologic MRI score at minimum 5 years after surgery. dGEMRIC indices and morphologic MRI scores were compared between and among groups using analysis of covariance/paired t tests. Results No significant difference was found between the global dGEMRIC indices of the study group (449 ± 147 ms, 95% CI 432-466 ms) and the control group (428 ± 143 ms, 95% CI 416-442 ms; P = 0.235). In regions with cartilage flaps, the study group showed higher dGEMRIC indices (472 ± 160 ms, 95% CI 433-510 ms) compared with the control group (390 ± 122 ms, 95% CI 367-413 ms; P < 0.001). No significant differences were found for the morphologic MRI scores. A strong inversely linear correlation between the dGEMRIC indices and the morphologic MRI scores ( r = −0.727, P < 0.001) was observed. Conclusions Treatment of acetabular cartilage flaps with subchondral drilling leads to better cartilage quality in regions with cartilage flaps at minimum 5 years of follow-up.

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“…23 In 2 hips micro fracturing of the acetabular bone with suturing of the labrum was performed. 25 Our postoperative protocol included the use of a continuous passive motion device to prevent capsular adhesions during hospital stay. After surgery, patients were mobilised with the use of crutches and partial weightbearing of 15 kg for at least 8 weeks.…”

Section: Methodsmentioning

confidence: 99%

Surgical hip dislocation with femoral osteotomy and bone grafting prevents head collapse in hips with advanced necrosis

et al. 2019

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Questions: Does surgical hip dislocation with drilling or bone grafting, cartilage treatment and femoral osteotomy in avascular necrosis of the femoral head (AVN) result in: (1) progression of osteonecrosis or osteoarthritis; (2) pain relief and improved function; and (3) subsequent surgery and complications? Methods: We retrospectively reviewed 12 patients (13 hips, mean age 29 ± 9 years) undergoing surgical hip dislocation for AVN. Preoperative ARCO stages were: 1 hip ARCO II, 8 hips ARCO III early, 4 hips ARCO III late. Drilling was performed in 4 hips, 9 hips underwent curettage, drilling and autologous bone grafting. Cartilage was sutured in 5 hips, autologous matrix-induced chondrogenesis was performed in 3 hips, an osteochondral autograft was used in 1 hip. Femoral osteotomy was performed in 10 hips. Mean follow-up was 3 ± 2 years. Progression of AVN and osteoarthritis was assessed preoperatively and at latest follow-up using Tönnis and ARCO staging. Pain and function were assessed with the Merle d’Aubigné-Postel score. Complications were graded according to Sink et al. Results: 1 hip had AVN progression and converted to THA. 9 hips showed no AVN- or advanced osteoarthritis progression and 3 hips improved at least 1 ARCO stage. The Merle d’Aubigné-Postel score increased from preoperatively 14.1 ± 3.2 to 16.6 ± 1.2 ( p = 0.012). Subsequent surgery were performed in 3 hips, complications occurred in 3 hips. Conclusion: Although the first results are promising a longer follow-up with more patients is needed to draw a definite conclusion regarding the joint preserving potential in AVN.

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Subchondral drilling for chondral flaps reduces the risk of total hip arthroplasty in femoroacetabular impingement surgery at minimum five years follow-up

Abstract: Subchondral drilling under acetabular chondral flaps during surgical treatment of FAI is an effective procedure to reduce the rate of conversion to THA.

Cited by 5 publications

References 34 publications

Treatment of Full-Thickness Acetabular Chondral Flaps During Hip Arthroscopy: Bone Marrow Aspirate Concentrate Versus Microfracture

Treatment of Full-Thickness Acetabular Chondral Flaps During Hip Arthroscopy: Bone Marrow Aspirate Concentrate Versus Microfracture

Improved Cartilage Quality on Delayed Gadolinium-Enhanced MRI of Hip Cartilage after Subchondral Drilling of Acetabular Cartilage Flaps in Femoroacetabular Impingement Surgery at Minimum 5-Year Follow-Up

Surgical hip dislocation with femoral osteotomy and bone grafting prevents head collapse in hips with advanced necrosis

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