Few surgical options exist to treat large chondral and osteochondral defects involving the articular surface of the hip. This challenging problem is often encountered in young, active patients whom may be best served with biologic joint preservation. Although restorative procedures for chondral and osteochondral defects in other joints such as the knee and ankle have demonstrated excellent outcomes in the literature, similar procedures for the articular surface of the hip have lagged behind. Therefore, restorative procedures in the hip present a tremendous area of opportunity for progress in the realm of hip preservation surgery. Recent advancements in the field, including the development of a safe anatomic and reliable surgical approach to the hip, have allowed the application of restorative procedures for chondral defects of the hip. This chapter outlines the indications and the surgical technique of two surgical options for hip preservation in the setting of large chondral or osteochondral defects of the femoral head and acetabulum: osteochondral autograft transfer and osteochondral allograft transplant. The current body of literature as it pertains to the use of these techniques in the hip is also reviewed.
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