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Surgical Hip Dislocation and Fresh Osteochondral Allograft Transplantation for Femoroacetabular Impingement and Concomitant Chondral Lesion.

ABSTRACT: Chondral lesions of the hip in young patients are frequently associated with additional articular pathology. Parafoveal osteochondral lesions have been reported to be a manifestation of cam lesions in the setting of femoroacetabular impingement (FAI). Although arthroscopic surgery is useful to treat intra- and extra-articular pathology, large lesions located in areas that are difficult to access represent a limitation of the technique. Open surgical dislocation and osteochondral allograft transplantation (OCA) allow treatment of larger surface areas and underlying morphologic abnormalities such as cam lesions. We present our technique for open surgical dislocation of the hip through a stepped trochanteric osteotomy, osteochondral transplantation of fresh-stored femoral head allograft, and osteoplasty of the head/neck junction.

SUBMITTER: Garcia-Mansilla I

PROVIDER: S-EPMC7768051 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:PurposeTo identify postoperative complications and risk factors associated with hip fracture and dislocation following primary arthroscopic surgical management of femoroacetabular impingement (FAI) syndrome.MethodsMarketScan was queried to identify patients who underwent FAI surgery from 2007 to 2016. Patients were stratified into 2 groups: acetabuloplasty only or femoroplasty only. A subanalysis of combined acetabuloplasty and femoroplasty also was undertaken. Surgical outcomes were followed postoperatively for 180 days. Multivariate logistic regression was used to control for with an alpha value of 0.05 set as significant.ResultsThis study identified 13,809 patients (mean age, 36.3 years) who underwent primary acetabuloplasty or femoroplasty. We also identified 10,026 patients who underwent both procedures. Postoperative complication rates were similar between the cohorts (acetabuloplasty 17.1%, femoroplasty 19.9%, P = .0622). Rates of hip fracture (femoroplasty: 2.4% vs acetabuloplasty: 2.0%, P = .0302) and heterotopic ossification (femoroplasty: 11.3% vs acetabuloplasty: 8.8%, P < .0001) were greater in the femoroplasty-only cohort. Combined acetabuloplasty and femoroplasty was associated with the greatest complication burden of 21.6% (P < .0001). After multivariate regression, differences in age, sex, comorbid status, or procedure type did not influence odds in risk for postoperative hip dislocation. Adjusted data showed that neither femoroplasty nor acetabuloplasty influenced odds of hip fracture (P > .05). Patients who were aged younger than 20 years old were significantly less likely to fracture their hips postoperatively than patients aged 60+ years (odds ratio 0.3, 95% confidence interval 0.1-0.8). Hypertension was independently associated with increased odds of hip fracture (odds ratio 1.7, 95% confidence interval 1.2-3.5).ConclusionsOlder age, male sex, and hypertension all carry increased risk for a hip fracture following acetabuloplasty or femoroplasty. Patient- and procedure-specific factors that could be assessed with this database did not influence risk for hip dislocation.Level of evidenceLevel III; retrospective comparative observation trial.

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Surgical Hip Dislocation and Fresh Osteochondral Allograft Transplantation for Femoroacetabular Impingement and Concomitant Chondral Lesion.

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