[Description of a technique that uses Lapidus arthrodesis plus osteochondral autotransplantation in the treatment of severe hallux rigidus].

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Abstract

[Indexed for MEDLINE] 14. Int Orthop. 2013 Jul;37(7):1239-44. doi: 10.1007/s00264-013-1893-6. Epub 2013 May 1. Clinical and radiological outcomes of treatment of avascular necrosis of the femoral head using autologous osteochondral transfer (mosaicplasty): preliminary report. Gagala J(1), Tarczyńska M, Gawęda K. Author information: (1)Orthopaedic Surgery and Traumatology, Medical University, Lublin, Poland. Comment in Int Orthop. 2013 Aug;37(8):1639-40. doi: 10.1007/s00264-013-1974-6. Int Orthop. 2013 Aug;37(8):1641-2. doi: 10.1007/s00264-013-1975-5. PURPOSE: The purpose of this study was to evaluate clinical and radiological outcomes of autologous osteochondral transfer (OATS) for femoral head osteonecrosis. METHODS: Twenty-one hips in 20 patients (one woman and 19 men), average patients' age at the time of surgery of 35.4 (range 20-56) years, were treated with OATS for osteonecrosis of the femoral head (ONFH). Seven patients at pre-collapse ARCO stages IIA and IIB were treated with OATS alone. Thirteen patients with large pre-collapse ARCO IIC and post-collapse ARCO III and IV were treated with OATS and morselised bone allografts (OATS/allograft). Harris hip score (HHS) was used for clinical evaluation of outcomes; X-rays were performed to examine the evolution of the disease. Kaplan-Meier survival curves were used to determine the failure of the procedures with conversion to THR defined as endpoint. RESULTS: Follow-up of patients treated with OATS alone was 46.14 (range 18-75) months with HHS improvement from a preoperative mean of 42 to 87.85 points at the latest follow-up examination. Only one patient in this group needed a revision operation with THR. The survival for this group of patients was 85.71 % at four years. Follow-up of patients treated with AOTS/allograft was 32.7 (range 7-84) months with HHS improvement from a preoperative mean of 35.2 to 65.7 points at the latest follow-up examination. One patient died six months after the surgery. There were five conversions to THR because of femoral head collapse in this group of patients with survival of 61.54 % at three years. CONCLUSION: The use of osteochondral grafts offers the possibility of successful treatment for ONFH at small and medium pre-collapse stages. The outcomes of large pre-collapse and post-collapse stages were below our expectations. OATS is a time buying procedure for young patients as it may defer total hip replacement. DOI: 10.1007/s00264-013-1893-6 PMCID: PMC3685652