Treatment of focal osteochondral defects of the acetabulum with osteochondral allograft transplantation

To our knowledge, treatment of focal osteochondral defects of the acetabulum with osteochondral allograft transplantation has not been described. As with osteochondral lesions of other weight-bearing surfaces, these defects may lead to disabling pain and early degenerative changes. In older patients who fail nonoperative treatment, hip arthroplasty is a reliable option to obtain pain relief and restore function. However, in young and active patients, it may be advantageous to restore joint congruity biologically. The clinical success of osteochondral allograft transplantation in the femoral condyles has been well-documented, with over 25 years of experience. We propose similar treatment principles in the hip joint. This article presents the cases of a 24-year-old woman (patient 1) and a 32-year-old man (patient 2) with hip pain and dysfunction secondary to a focal osteochondral defect of the acetabulum. Both were treated with osteochondral allograft transplantation to the defect using a dowel technique. A magnetic resonance image at 18 months in both cases demonstrated incorporation of the allograft bone into the host acetabulum. At 24 months in patient 1 and 42 months in patient 2, radiographs showed no progressive osteoarthritis. Both patients' Hip Outcome Scores were 100 points each. Osteochondral allografts allow large areas to be resurfaced without donor site morbidity, and these grafts provide an immediate functional joint surface. Although it has not been proven in terms of long-term follow-up, we believe that osteochondral allograft transplantation for focal osteochondral defects of the acetabulum in young, active patients is a feasible option to restore joint congruity.