Background: Osteochondral allograft transplant and autograft transplant for femoral head defects have emerged as promising treatments for concomitant cartilage and subchondral bone injuries in young patients. Purpose: To evaluate the clinical and radiological outcomes of patients who underwent osteochondral allograft or autograft transplant for femoral head defects and identify any risk factors that may lead to conversion to total hip arthroplasty (THA). Study Design: Case series; Level of evidence, 4. Methods: All patients who underwent osteochondral allograft or autograft transplant for femoral head defects across 2 institutions were analyzed. Clinical outcomes were assessed at final follow-up with the modified Harris Hip Score (mHHS), Hip Outcome Score–Activities of Daily Living (HOS-ADL), Hip Outcome Score–Sport-Specific Subscale (HOS-SSS), and International Hip Outcome Tool (iHOT-12). Complications and reoperations were recorded. Patients were assessed radiographically preoperatively and at final follow-up for osteoarthritis using Tönnis grading. Results: A total of 27 patients were included in this study (19 osteochondral allograft transplant, 8 osteochondral autograft transplant). The mean follow-up for the allograft and autograft cohorts was 2.8 and 9.5 years, respectively. The mean defect size for patients who underwent allograft and autograft transplant was 2.8 × 2.1 cm and 1.6 × 1.0 cm, respectively. The mean mHHS, HOS-ADL, HOS-SSS, and iHOT-12 for the allograft cohort were 86.7, 92.8, 81.4, and 79.0, respectively, and for the autograft cohort were 87.6, 92.7, 83.1, and 82.0, respectively. No significant difference in outcomes was noted for patients who underwent femoral head allograft versus nonorthotopic femoral condyle allograft transplant. For the allograft cohort, 4 patients (21.1%) underwent conversion to THA at a mean of 1.9 years. Of the remaining 15 allograft patients, only 1 patient (6.7%) had radiographic osteoarthritis progression. None of the patients in the autograft cohort underwent conversion to THA. Conclusion: Osteochondral allograft and autograft transplant for femoral head defects demonstrated overall favorable clinical outcomes and rates of conversion to THA. Additionally, nonorthotopic femoral condyle allografts demonstrated similar outcomes to femoral head allografts. Both osteochondral allograft and autograft transplant should be considered for patients with focal femoral head defects.

中文翻译：

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同种异体骨软骨移植物和自体移植物治疗股骨头缺损：一项多中心研究


背景： 同种异体骨软骨移植和自体移植治疗股骨头缺损已成为治疗年轻患者伴随软骨和软骨下骨损伤的有前途的治疗方法。目的： 评估因股骨头缺损而接受同种异体骨软骨移植或自体移植的患者的临床和放射学结局，并确定可能导致转为全髋关节置换术 （THA） 的任何危险因素。研究设计：病例系列;证据水平，4.方法： 对 2 个机构中所有因股骨头缺损而接受同种异体骨软骨移植或自体移植的患者进行分析。在最终随访时，使用改良的 Harris 髋关节评分 （mHHS） 、髋关节结果评分 - 日常生活活动 （HOS-ADL） 、髋关节结果评分 - 运动特异性分量表 （HOS-SSS） 和国际髋关节结果工具 （iHOT-12） 评估临床结果。记录并发症和再次手术。使用 Tönnis 分级对患者术前和最终随访进行骨关节炎的放射学评估。结果： 本研究共纳入 27 例患者 （19 例同种异体骨移植移植，8 例骨软骨自体移植移植）。同种异体移植和自体移植队列的平均随访时间分别为 2.8 年和 9.5 年。接受同种异体移植和自体移植的患者的平均缺损大小分别为 2.8 × 2.1 cm 和 1.6 × 1.0 cm。同种异体移植队列的平均 mHHS 、 HOS-ADL 、 HOS-SSS 和 iHOT-12 分别为 86.7 、 92.8 、 81.4 和 79.0，自体移植队列的平均 mHS 、 HOS-ADL 、 HOS-SSS 和 iHOT-12 分别为 87.6 、 92.7 、 83.1 和 82.0。接受股骨头同种异体移植物与非原位股骨髁同种异体移植物移植的患者在结局上没有显著差异。 对于同种异体移植队列，4 例患者 （21.1%） 在平均 1.9 年时接受了 THA 的转化。在其余 15 例同种异体移植患者中，只有 1 例患者 （6.7%） 出现影像学骨关节炎进展。自体移植队列中没有患者接受 THA 的转化。结论： 股骨头缺损的同种异体骨软骨移植和自体移植显示出总体良好的临床结果和转化为 THA 的比率。此外，非原位股骨髁同种异体移植物显示出与股骨头同种异体移植物相似的结果。对于局灶性股骨头缺损患者，应考虑同种异体骨软骨移植和自体移植。