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Arthroscopic-Assisted Intraosseous Bioplasty of the Acetabulum.

ABSTRACT: Intraosseous bioplasty (IOBP), has been previously described for arthroscopic-assisted treatment of subchondral bone cysts in the proximal tibia associated with early stages of knee osteoarthritis (OA). This technique entails combining bone marrow aspirate concentrate or concentrated platelet-rich plasma with demineralized bone matrix as a bone substitute before injecting into a subchondral bone defect under fluoroscopic guidance. The principles of IOBP as a procedure that combines core decompression with biologic bone substitute augmentation can be extended to treat subchondral bone marrow lesions such as acetabular and femoral cysts in degenerative hip OA. Intraosseous bioplasty of the hip, in particular the acetabulum, when done using this technique, is a useful alternative that can be beneficial in treating young patients with early hip arthritis to achieve successful outcomes while delaying more invasive procedures. The Technical Note described here presents a step-by-step approach, including tips and pearls for arthroscopic-assisted IOBP with decompression of the subchondral cyst in the acetabulum followed by bone substitute injection under fluoroscopic guidance. We believe this method is a safe and reproducible way to treat subchondral defects in young patients with signs of early osteoarthritis of the hip joint.

SUBMITTER: Ankem HK

PROVIDER: S-EPMC7587331 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:ObjectiveTo perform a systematic review to determine the current arthroscopic techniques of the fixation of femoral head and acetabulum fractures and assess the radiological and functional outcomes reported in literature written in English.MethodsThis review was performed by searching PubMed, Cochrane Library, Scopus, and Web of Science without a filter for time limitation in line with Preferred Reporting Items for Systematic Reviews Protocols (PRISMA-P) guidelines. Two authors took part in screening and evaluating the literature between December 2020 and January 2021. The terms acetabulum fracture, reduction, fixation, femur head fracture, fracture dislocation of the hip, hip trauma and arthroscopy or arthroscopic, and their combinations were used to search four database engines in the titles and abstracts of the reported papers. Only papers with English titles and abstracts were included. The assessment of the data related to descriptions of the techniques, indications for fracture fixation using arthroscopy, and patient-related outcomes.ResultsPerfect agreement was detected between the two reviewers during all steps of the review process (κ = 0.81-1.00). Although a meta-analysis was planned to be carried out, no randomized controlled study comparing either the radiological or functional results of different surgical techniques was detected in the literature. Nineteen studies were included in the study. Of these, 15 were retrospective case reports and four were case series. Twenty-seven patients were operated on for acetabulum fractures (18 male/nine female). The mean age was 28.3 years (range, 15-53 years). High-energy traumas including motor vehicle accidents were the most common reason (81%). The duration of follow-up was a mean of 32 months (range, 12-68 months). Sixteen patients were operated on for femur fractures (12 male/three female). The mean age was 30.1 years (range, 17-50 years). Motor vehicle accident was the most common trauma (70%). Duration of follow-up had a mean of 18 months (range, 4-60 months). Patient-related outcomes were excellent for reported cases in both groups despite the fact that an objective scoring system was not used for most of the cases. Moreover, there was no consensus on surgical indications or the techniques.ConclusionsThe techniques of arthroscopic-assisted fixation of acetabulum and femoral head fracture are so heterogeneous that conclusions cannot be made at this time, but there is potential for this method of treatment to become more popular as the devices used in the procedure develop and as exposure to and experience with hip arthroscopy improves. Further descriptions of reduction and fixation techniques and analysis of outcomes of RCTs are needed.

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Arthroscopic-Assisted Intraosseous Bioplasty of the Acetabulum.

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