New York City—January 29, 2010
“This novel technique can help young patients to delay, or even possibly avoid altogether, the need for a total hip replacement,” said David L. Helfet, M.D., director of the Orthopedic Trauma Service at Hospital for Special Surgery. Hip replacements typically last 20 to 25 years, so a younger person who undergoes a hip replacement is likely to need multiple hip replacement surgeries/revisions in the span of his or her lifetime. Only one similar case report was found in the literature at the time of preparation of the present manuscript. This case was also a success, and doctors say the studies provide encouragement to clinicians that this type of surgery can be of benefit to other patients with similar injuries.
In certain high-energy accidents such as motor vehicle accidents or when a person falls off a ladder, fractures of the so-called femoral head can occur. The hip consists of a ball and socket joint and a femoral head fracture is an injury to the ball portion of the joint. In high-energy accidents, the femur can be forced to dislocate beyond the socket often causing a femoral head fracture, sometimes with an associated fracture to the hip socket. In the past, femoral head fractures with a bone and cartilage defect were treated primarily with a total hip replacement; which as stated is less than ideal in a young patient who would likely need multiple revision surgeries in their lifetime.
The case reported by researchers at Hospital for Special Surgery involved an injury to an 18-year-old man who was a belted driver involved in a motor vehicle collision, striking a pole. After being admitted and observed at the initial hospital, he was assessed as having a small fracture of the femoral head and was released on crutches. Twenty days following the injury, he presented at Hospital for Special Surgery. Computed tomography (CT) and magnetic resonance imaging (MRI) examinations were performed, which further delineated the large displaced section of the femoral head and a small associated fracture to the periphery of the hip socket (acetabulum).
Surgery was then performed, by orthopedic surgeons Dr. Helfet and Dr. Robert L. Buly, using a new technique that involves surgical dislocation of the femur in order to access and repair the fracture. Because one-third of the femoral head was missing due to the severe damage associated with the injury, doctors chose to transplant a special piece of frozen bone/cartilage. Hospitals, especially those with larger orthopedic surgery departments, have bone bank facilities that store bone and cartilage tissue based on surgical indications. Once thawed, the cartilage and bone were shaped to fit into the defect. The transplant was then anchored into place with two small headless screws.
“This is one of the first such case reports describing this procedure in the orthopaedic literature,” said Dr. Helfet. “The patient has had an early good functional recovery following such a severe injury to his hip joint.”
Post-operatively, the patient was on crutches, only 20 lbs weight bearing for two months, but he was told to avoid rigorous activities requiring further exertion. Subsequently, the patient was allowed to slowly progress to weight bearing as tolerated and work on obtaining full range of motion and strength of the hip. The patient returned for regular follow-up visits and x-rays of the hip revealed that the graft had properly incorporated. At 46 months following surgery, the patient is fully rehabilitated, was able to successfully complete his education, and has been able to return to the active life he enjoyed before the injury. Further studies with long-term results are needed, but the early results are promising.
“The surgery was a success. His 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.” said Dr. Helfet. “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.”
Other authors involved in the case report are Markku T. Nousiainen, M.D,, from Sunnybrook Health Sciences Centre, University of Toronto; Milan K. Sen, M.D., from the University of Texas Medical Center at Houston; and Douglas N. Mintz, M.D., Dean G. Lorich, M.D., Omesh Paul, M.D., and Robert L. Buly, M.D., from Hospital for Special Surgery.
About HSS | Hospital for Special Surgery
HSS is the world’s leading academic medical center focused on musculoskeletal health. At its core is Hospital for Special Surgery, nationally ranked No. 1 in orthopedics (for the eighth consecutive year) and No. 3 in rheumatology by U.S. News & World Report (2017-2018). Founded in 1863, the Hospital has one of the lowest infection rates in the country and was the first in New York State to receive Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center four consecutive times. The global standard total knee replacement was developed at HSS in 1969. An affiliate of Weill Cornell Medical College, HSS has a main campus in New York City and facilities in New Jersey, Connecticut and in the Long Island and Westchester County regions of New York State. In 2017 HSS provided care to 135,000 patients and performed more than 32,000 surgical procedures. People from all 50 U.S. states and 80 countries travelled to receive care at HSS. In addition to patient care, HSS leads the field in research, innovation and education. The HSS Research Institute comprises 20 laboratories and 300 staff members focused on leading the advancement of musculoskeletal health through prevention of degeneration, tissue repair and tissue regeneration. The HSS Global Innovation Institute was formed in 2016 to realize the potential of new drugs, therapeutics and devices. The culture of innovation is accelerating at HSS as 130 new idea submissions were made to the Global Innovation Institute in 2017 (almost 3x the submissions in 2015). The HSS Education Institute is the world’s leading provider of education on the topic on musculoskeletal health, with its online learning platform offering more than 600 courses to more than 21,000 medical professional members worldwide. Through HSS Global Ventures, the institution is collaborating with medical centers and other organizations to advance the quality and value of musculoskeletal care and to make world-class HSS care more widely accessible nationally and internationally.