Osteochondral Allografting of the Hip

Abstract

Recent advances in hip arthroscopy and cartilage imaging have led to increased understanding and acceptance of the concept of femoroacetabular impingement, which in turn has fueled an emerging trend toward biological restoration and hip preservation as an alternative to prosthetic joint replacement. Although total hip arthroplasty remains the gold standard treatment for end-stage osteoarthritis and failure endpoint in most clinical studies, longevity concerns make it a reluctant choice in an exceedingly active and actively aging patient population. The focus of treatment has thus been shifted to correcting morphological conflicts and addressing focal chondral or osteochondral lesions to prevent disease progression to end-stage joint degeneration. Fresh osteochondral allografts are composite grafts consisting of a viable mature hyaline cartilage portion anchored to a nonviable subchondral bone portion. This forms a structural and functional osteoarticular unit that may replace a corresponding segment of a recipient joint in the face of disease or injury. Although multiple studies have reported encouraging results for osteochondral allografting in the knee, indications for the use of this approach in the hip continue to evolve.