Abstract：
BACKGROUND: The surgical management of large osteochondral lesions of the femoral head in young, active patients remains controversial. Fresh osteochondral allograft (OCA) transplantation can be a highly effective treatment for these lesions in some patients. This study investigated survivorship as well as clinical and radiographic outcomes after fresh OCA transplantation at a minimum 2-year follow-up (mean, 6.6 years; range, 0.6 to 13.7 years).
METHODS: A retrospective review of 29 patients who underwent plug OCA transplantation for focal femoral head osteochondral lesions between 2008 and 2021 was performed. Patients were assessed clinically using the modified Harris Hip score (mHHS) preoperatively and at each follow-up visit. Postoperative radiographs were evaluated for graft integrity and osteoarthritis severity. Kaplan-Meier survivorship analyses with 95% confidence intervals (CIs) were performed for the endpoint of conversion to total hip arthroplasty (THA).
RESULTS: Overall graft survivorship for included patients was 78.4% (95% CI: 62.9 to 93.9) and 62.7% (95% CI: 39.6 to 85.8) at 5 and 10 years, respectively. There were ten patients (34.5%) who underwent conversion to THA. There was a significant difference using the log-rank test between survival for patients who had a preoperative diagnosis of osteonecrosis (ON) versus those who had other diagnoses (P = .002). The ten-year survival for those who had ON was 41.8% (95% CI: 4.8 to 78.8), and the ten-year survival for diagnoses other than ON was 85.7% (95% CI: 59.8 to 100). The mean mHHS score improved significantly (P < .001) from 48.9 (19 to 84) preoperatively to 77.4 (35 to 100) at the final follow-up. There were twenty patients (69.0%) who had mHHS ≥ 70 at the latest follow-up. Arthritic progression, indicated by an increase in the Kellgren and Lawrence grade, occurred in 7 hips (26.9%).
CONCLUSIONS: An OCA transplantation is a viable treatment option for osteochondral defects of the femoral head in young, active patients who have minimal preexisting joint deformity. It may delay the progression of arthritis and the need for THA. Patients who had a preoperative diagnosis of ON had worse clinical outcomes than those who had other diagnoses.
METHODS: A retrospective review of 29 patients who underwent plug OCA transplantation for focal femoral head osteochondral lesions between 2008 and 2021 was performed. Patients were assessed clinically using the modified Harris Hip score (mHHS) preoperatively and at each follow-up visit. Postoperative radiographs were evaluated for graft integrity and osteoarthritis severity. Kaplan-Meier survivorship analyses with 95% confidence intervals (CIs) were performed for the endpoint of conversion to total hip arthroplasty (THA).
RESULTS: Overall graft survivorship for included patients was 78.4% (95% CI: 62.9 to 93.9) and 62.7% (95% CI: 39.6 to 85.8) at 5 and 10 years, respectively. There were ten patients (34.5%) who underwent conversion to THA. There was a significant difference using the log-rank test between survival for patients who had a preoperative diagnosis of osteonecrosis (ON) versus those who had other diagnoses (P = .002). The ten-year survival for those who had ON was 41.8% (95% CI: 4.8 to 78.8), and the ten-year survival for diagnoses other than ON was 85.7% (95% CI: 59.8 to 100). The mean mHHS score improved significantly (P < .001) from 48.9 (19 to 84) preoperatively to 77.4 (35 to 100) at the final follow-up. There were twenty patients (69.0%) who had mHHS ≥ 70 at the latest follow-up. Arthritic progression, indicated by an increase in the Kellgren and Lawrence grade, occurred in 7 hips (26.9%).
CONCLUSIONS: An OCA transplantation is a viable treatment option for osteochondral defects of the femoral head in young, active patients who have minimal preexisting joint deformity. It may delay the progression of arthritis and the need for THA. Patients who had a preoperative diagnosis of ON had worse clinical outcomes than those who had other diagnoses.
摘要：
背景：年轻的股骨头大骨软骨损伤的外科治疗，活跃的患者仍然存在争议。新鲜的骨软骨同种异体移植（OCA）移植可以是某些患者这些病变的高效治疗方法。这项研究调查了至少2年随访的新鲜OCA移植后的存活率以及临床和影像学结果（平均，6.6年；范围，0.6-13.7年）。
方法：回顾性分析了在2008年至2021年期间因股骨头局灶性骨软骨损伤而接受堵塞性OCA移植的29例患者。术前和每次随访时使用改良的Harris髋关节评分（mHHS）对患者进行临床评估。术后X线片评估移植物完整性和骨关节炎严重程度。对转行全髋关节置换术（THA）的终点进行了95%置信区间的Kaplan-Meier生存分析。
结果：在5年和10年时，纳入患者的移植物总存活率分别为78.4%（95%CI：62.9至93.9）和62.7%（95%CI：39.6至85.8），分别。有10例患者（34.5％）转换为THA。使用对数秩检验，术前诊断为骨坏死（ON）的患者与其他诊断的患者的生存率之间存在显着差异（P=0.002）。患有ON的患者的十年生存率为41.8％（95％CI：4.8至78.8），除ON以外的诊断的10年生存率为85.7%(95%CI:59.8~100).平均mHHS评分从术前的48.9(19至84)显著改善(P<0.001)至最终随访时的77.4(35至100)。在最新的随访中，有20例患者（69.0％）的mHHS≥70。关节炎进展,KL等级的增加表明，发生在七个臀部（26.9％）。
结论：OCA移植是治疗年轻股骨头骨软骨缺损的可行选择，有最小的预先存在的关节畸形的活跃患者。它可能会延迟关节炎的进展和对THA的需要。术前诊断为ON的患者的临床结果比其他诊断的患者差。
方法：回顾性分析了在2008年至2021年期间因股骨头局灶性骨软骨损伤而接受堵塞性OCA移植的29例患者。术前和每次随访时使用改良的Harris髋关节评分（mHHS）对患者进行临床评估。术后X线片评估移植物完整性和骨关节炎严重程度。对转行全髋关节置换术（THA）的终点进行了95%置信区间的Kaplan-Meier生存分析。
结果：在5年和10年时，纳入患者的移植物总存活率分别为78.4%（95%CI：62.9至93.9）和62.7%（95%CI：39.6至85.8），分别。有10例患者（34.5％）转换为THA。使用对数秩检验，术前诊断为骨坏死（ON）的患者与其他诊断的患者的生存率之间存在显着差异（P=0.002）。患有ON的患者的十年生存率为41.8％（95％CI：4.8至78.8），除ON以外的诊断的10年生存率为85.7%(95%CI:59.8~100).平均mHHS评分从术前的48.9(19至84)显著改善(P<0.001)至最终随访时的77.4(35至100)。在最新的随访中，有20例患者（69.0％）的mHHS≥70。关节炎进展,KL等级的增加表明，发生在七个臀部（26.9％）。
结论：OCA移植是治疗年轻股骨头骨软骨缺损的可行选择，有最小的预先存在的关节畸形的活跃患者。它可能会延迟关节炎的进展和对THA的需要。术前诊断为ON的患者的临床结果比其他诊断的患者差。
