Midterm Outcomes of Osteochondral Allograft Transplantation for Femoral Head Cartilage Lesions: Minimum Two-Year Follow-Up

The surgical management of large osteochondral lesions of the femoral head in young, active patients remains controversial. Fresh osteochondral allograft transplantation (OAT) can be a highly effective treatment for these lesions in some patients. We study the midterm survivorship and outcomes after fresh osteochondral allograft transplantation at minimum 2-year follow-up. A retrospective review of prospectively collected data was performed for 28 patients (12 female) under the age of 50 years with defined femoral head osteochondral lesions who underwent fresh OAT between 2008 and 2021. Patients were assessed clinically using the modified Harris Hip Score (mHHS) preoperatively and at each follow-up visit. Postoperative radiographs were evaluated for graft integrity and Kellgren & Lawrence Grade for osteoarthritis severity. Complications and reoperation were assessed by chart review. Kaplan-Meier survivorship analyses with 95% confidence intervals were performed for the end point of conversion to total hip arthroplasty. Overall graft survivorship for included patients is 62.7% (39.6-85.8, 95% CI) at 10 years. Nine patients (32.1%) underwent conversion to total hip arthroplasty. There was a significant difference using log rank test between survival for patients with a preoperative diagnosis of avascular necrosis (AVN) versus those with other diagnosis (osteochondritis dissecans and trauma) (P=0.002). At a mean follow-up of 79.7 months (25-164), the mean mHHS score impoved significantly (P Fresh OAT is a viable treatment option for osteochondral defects of the femoral head in young, active patients with minimal preexisting joint deformity. It may delay the need for total hip arthroplasty. Patients with a preoperative diagnosis of AVN had poorer clinical outcomes than those with other diagnoses.