Abstract
Background
Autologous Chondrocyte Implantation (ACI) is a procedure which is gaining acceptance for the treatment of cartilage defects in the knee with good results and a long term durable outcome. Its use in other joints has been limited, mainly to the ankle. We aimed to assess the outcome of ACI in the treatment of chondral and osteochondral defects in the hip.
Methods
Fifteen patients underwent ACI for chondral or osteochondral defects in the femoral head with a follow up of upto 8 years (mean of 2 years) in our institution with a mean age of 37 years at the time of operation. Pre-operatively hip function was assessed by using the Harris Hip Score and MRI. Post-operatively these were repeated at 1 year and hip scores repeated annually. Failure was defined as a second ACI to the operated lesion or a conversion to a hip resurfacing or replacement.
Results
The mean pre-op Harris Hip Score (HHS) was 55 which increased to 63 at 1 year and 70 at the latest follow up. Patients who underwent ACI for cartilage defects secondary to trauma (four) were better with a mean HHS of 69 at a mean follow up of 3.5 years. Six patients underwent THR at a mean of 32 months and were classed as failures. Five patients had evidence of avascular necrosis (AVN) of the femoral head post operatively of which four AVN pre-op.
Conclusion
These early results suggest that ACI could be a viable option for the treatment of isolated chondral defects in the hip. The presence of AVN or bone cysts pre-op may be a predictor of failure.
