Orthopedic surgery using allograft shows promising results for hip fractures

Orthopedics Today—February 1, 2010

A novel surgery using osteochondral allograft may help young patients with severe femoral head fractures avoid total hip arthroplasty, according the results of a case study conducted by investigators at Hospital for Special Surgery.

“This novel technique can help young patients to delay, or even possibly avoid altogether, the need for a total hip replacement,” David L. Helfet, MD, an author of the study and director of the Orthopedic Trauma Service at the hospital, stated in a Hospital for Special Surgery (HSS) press release.

The study, which appears in the Journal of Orthopaedic Trauma, detailed the case of an 18-year-old man who was involved in a motor vehicle accident. An initial hospital assessed the patient as having a small femoral head fracture and he was released on crutches. However, MRI and CT examinations of the patient performed at HSS 20 days after the injury revealed a large, displaced femoral head fracture and a small fracture located at the periphery of the acetabulum.

Helfet and his colleague, Robert L. Buly, MD, performed surgery on the patient using the new technique that included surgically dislocating the femur to access and repair the fracture. The surgeons used osteochondral allograft to fill the defect and anchored the transplant using two small headless screws, according to the release.

“This is one of the first such case reports describing this procedure in the orthopedic literature,” Helfet stated in the release. “The patient has had an early good functional recovery following such a severe injury to his hip joint.”

The patient was on crutches postoperatively and allowed 20 pounds weight-bearing for 2 months. He then progressed to weight-bearing as tolerated. Follow-up X-rays revealed graft incorporation, and the patient returned to his active lifestyle 46 months postoperatively.

“The surgery was a success,” Helfet stated in the release. “He is currently working as a mechanic for a country club. He was able to return to complete his education and perform a physically demanding job. The advantage of this surgery is the ability to delay or even avoid altogether a total hip replacement. Even more importantly, the longer a hip replacement can be delayed in a younger patient, the better, because there is less chance of one or multiple subsequent revision surgeries.”

Read the full story at OrthoSupersite.com.

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