Acetabular chondral delamination is a frequent finding at hip arthroscopy. The cartilage is macroscopically normal but disrupted from the subchondral bone. Excision of chondral flaps is the usual procedure for this type of lesion. However, we report 19 consecutive patients in whom the delaminated chondral flap was re-attached to the underlying subchondral bone with fibrin adhesive. We used the modified Harris hip score for assessment of pain and function. Improvement in pain and function was found to be statistically significant six months and one year after surgery. No local or general complications were noted. Three patients underwent further surgery for unrelated reasons. In each, the area of fibrin repair appeared intact and secure. Our results suggest that fibrin is a safe agent to use for acetabular chondral delamination.
Isolated osteochondral defects (OCD) of the femoral head remain a challenging issue for the surgeons when trying to balance between a less invasive procedure and the maximum benefit for the patient. We present our experience of the Hemicap partial hip resurfacing system in 12 patients. In ten patiens the defects were identified arthroscopically. Seven of them had concurrent early degeneration of cartilage (OA, Grade I). Three patients had OCD surrounded by normal cartilage and two patients had avascular necrosis. The mean patient age was 41 years (30 to 63) and mean follow-up 27 months (range 9 to 48). Five patients required a hip resurfacing arthroplasty or total hip replacement at a mean interval of 17 months (12 to 24) due to persistent pain. Three patients required further hip arthroscopy at a mean interval of 36 months (range, 24 to 48). Four patients did not require secondary surgery with mean follow-up 32.7 months (range, 9 to 43). In all hips with revision surgery the components were found to be stable and secure. Partial resurfacing arthroplasty seems to have a tendency towards early failure, especially in OA patients, but more favourable results in AVN patients, and the surgeons should have a cautious approach to this type of arthroplasty.
