Surgical Technique: Second-generation Bone Marrow Stimulation via Surgical Dislocation to Treat Hip Cartilage Lesions

• Published in: Clinical orthopaedics and related research 2012-12, Vol.470 (12), p.3421-3431
• Main Authors: Leunig, Michael, Tibor, Lisa M., Naal, Florian D., Ganz, Reinhold, Steinwachs, Matthias R.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; arthroscopy; Autografts; Biomechanical Phenomena; Bone grafts; Bone marrow; Bone Marrow - pathology; Bone Transplantation - adverse effects; Cartilage; Cartilage, Articular - diagnostic imaging; Cartilage, Articular - pathology; Cartilage, Articular - physiopathology; Cartilage, Articular - surgery; Chondrogenesis; Collagen; Collagen - administration & dosage; Conservative Orthopedics; Data processing; Debridement; Dislocation; Female; Femoracetabular Impingement - diagnostic imaging; Femoracetabular Impingement - pathology; Femoracetabular Impingement - physiopathology; Femoracetabular Impingement - surgery; fibrin; Fibrin - administration & dosage; Gels; Hip; Hip Joint - diagnostic imaging; Hip Joint - pathology; Hip Joint - physiopathology; Hip Joint - surgery; Humans; Magnetic Resonance Imaging; Male; Medicine; Medicine & Public Health; Membranes, Artificial; N.M.R; Orthopedics; Osteotomy; Pain; Pain, Postoperative - etiology; Pain, Postoperative - prevention & control; Radiography; Recovery of Function; Retrospective Studies; Shoulder; Soft tissues; Sports Medicine; Surgery; Surgical Orthopedics; Symposium: ABJS Carl T. Brighton Workshop on Hip Preservation Surgery; Time Factors; Transplantation, Autologous; Treatment Outcome; Young Adult
• ISSN: 0009-921X; 1528-1132
• DOI: 10.1007/s11999-012-2466-5

Background Compared to knees, hips have more bony constraint and soft tissue coverage. Thus, repair of focal cartilage defects in hips requires more invasive and technically complex surgeries than simple arthroscopy or arthrotomy. Autologous matrix-induced chondrogenesis (AMIC) is a second-generation bone marrow stimulation technique. Improvement in Tegner, Lysholm, International Cartilage Repair Society (ICRS), and Cincinnati scores has been reported at 1 and 2 years after AMIC in knees. AMIC is potentially useful to repair defects in hips, but it is unknown whether it relieves symptoms or results in a durable construct. Description of Technique A surgical hip dislocation is used to access the defect. This is débrided to stable cartilage shoulders, necrotic bone is removed, and the lesion base is drilled. Autogenous bone graft is used for lesions with bony defects to create a level surface. Fibrin gel and a collagen membrane are placed to stabilize the superclot for fibrocartilage formation. Methods We treated six patients with AMIC in the hip between 2009 and 2010. We obtained Oxford Hip and UCLA Activity Scores. Repair quality was assessed on 6-month postoperative MRI using the modified magnetic resonance observation of cartilage repair tissue (MOCART) system. Minimum 1-year followup data were available for four patients (range, 1–2.5 years). Results Postoperative Oxford Hip Scores ranged from 13 to 17, UCLA Activity Scores ranged from 5 to 10, and MOCART scores ranged from 55 to 75. No complications occurred. Conclusions We describe AMIC in the hip. Although these patients had pain relief and improved function, long-term followup is necessary to assess the duration of improvement, durability of repair, and potential for arthrosis. Level of Evidence Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.