Purpose
To evaluate functional outcomes and survivorship in patients at 1 year after undergoing
arthroscopic microfracture augmented with hyaline allograft for symptomatic chondral
defects of the hip.
Methods
Consecutive patients with and without prior hip procedures presenting with Outerbridge
grade IV chondral lesion of the acetabulum or femoral head were prospectively followed.
Patients underwent hip microfracture augmented with hyaline allograft suspended in
autologous platelet-rich plasma between October 2016 and April 2018. Extent of cartilage
degeneration was quantified using the chondromalacia severity index (CMI). Patient
functional scores, including Tegner, Hip Outcome Score-Activities of Daily Living
(HOS-ADL), Sport-Specific Subscale (HOS-SSS), modified Harris Hip Score (mHHS), and
Nonarthritic Hip Score (NAHS) were collected preoperatively and at minimum 1-year
postoperatively. Minimal clinically important difference (MCID) was analyzed. Statistical
significance was established at P < .05. Pearson’s coefficient analysis was performed to identify preoperative variables
correlated with clinical outcomes.
Results
Fifty-seven patients (86.4%) had minimum 1-year follow-up and were included in the
final analysis, with a mean age and body mass index (BMI) of 38.3 ± 9.1 years and
27.7 ± 4.9 kg/m2, respectively. Comparison of baseline and postoperative score averages demonstrated
significant improvements in Tegner scores (3.7 ± 2.9 vs 5.1 ± 2.6; P = .003), HOS-ADL (63.3 ± 16.4 vs 89.1 ± 14.5; P < .001), HOS-SSS (40.8 ± 20.4 vs 79.5 ± 21.6; P < .001), mHHS (61.5 ± 16.2 vs 87.0 ± 17.7; P < .001), and NAHS (56.6 ± 14.9 vs 78.7 ± 18.3; P < .001). The percentage of patients who achieved MCID for HOS-ADL, HOS-SSS, mHHS,
and NAHS were 89.8%, 83.0%, 75.6%, and 81.6%, respectively. Overall, 91.8% of patients
met the threshold for achieving MCID in at least one outcome score. Of the 57 patients,
5 (8.8%) failed clinically, with 1 (1.8%) undergoing revision surgery and 4 (6.9%)
undergoing conversion to total hip arthroplasty. There was a direct correlation between
preoperative alpha angle and postoperative HOS-ADL. Femoral chondral lesion size and
CMI inversely correlated with postoperative HOS-ADL.
Conclusions
Treatment of hip chondral defects with microfracture and hyaline allograft augmentation
demonstrated excellent survivorship and significantly improved patient report outcomes
at 1 year.
Level of Evidence
IV, retrospective case series.
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Article Info
Publication History
Published online: March 02, 2022
Accepted:
February 20,
2022
Received:
August 16,
2021
Publication stage
In Press Journal Pre-ProofFootnotes
The authors report the following potential conflicts of interest or sources of funding: I.M.A. reports he is a board or committee member of the American Orthopaedic Society for Sports Medicine and an editorial or governing board member of Arthroscopy. A.J.S. is a board or committee member of AAOS, the American Board of Orthopaedic Surgery, Inc., the American Orthopaedic Society for Sports Medicine, International Society of Arthroscopy, Knee Surgery, ISHA, MASH Group, OSET, Inc / OSET Institute, The Hip Preservation Society, and Orthopaedic Sports Medicine and the Arthroscopy Association of North America. He is on the editorial or governing board of the Journal of Hip Preservation Surgery. He has received other financial or material support from Arthrex , CONMED Linvatec , and Smith & Nephew . He has received publishing royalties from Thieme. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
Identification
Copyright
© 2022 by the Arthroscopy Association of North America
