Novel Surgery Helps Trauma Patients Avoid Total Hip Replacements

An innovative surgical technique that uses transplanted cadaver bone and cartilage may help young patients avoid a hip replacement after a specific traumatic injury to the hip joint, according to a new case study.

Researchers at Hospital for Special Surgery (HSS, New York, NY, USA) and the University of Toronto (Canada) reported the case of an 18-year-old man who was involved in a motor vehicle collision, striking a telephone pole. He was initially assessed as having a small fracture of the femoral head and was released on crutches. Twenty days following the injury, he presented at the HSS after recurrent dislocation. Computed tomography (CT) and magnetic resonance imaging (MRI) examinations were performed, which delineated a large displaced section of the femoral head and a small associated fracture to the periphery of the acetabulum.

Surgery was then performed using a new technique that involves surgical dislocation of the femur in order to access and repair the fracture. Since one-third of the femoral head was missing due to the severe damage associated with the injury, the surgeons decided to transplant an osteochondral allograft section from the bone bank, which was shaped to fit into the defect. The transplant was then anchored into place with two small headless screws. After two months on crutches, 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. At 46 months following surgery, the patient was fully rehabilitated, and was able to return to an active lifestyle. The case report study was published in the February 2010 issue of the Journal of Orthopedic Trauma.

"The advantage of this surgery is the ability to delay or even avoid altogether a total hip replacement,” said David Helfet, M.D., director of the orthopedic trauma service at HSS. "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.”

In certain high-energy accidents, such as motor vehicle accidents or when a person falls off a ladder, fractures of the femur can 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; thus is less than ideal in a young patient, who would likely need multiple revision surgeries during their lifetime.

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Hospital for Special Surgery
University of Toronto