Clinical Orthopaedics and Related Research®

, Volume 468, Issue 2, pp 613–618

Case Report: Fresh-Stored Osteochondral Allograft for Treatment of Osteochondritis Dissecans the Femoral Head

Case Report


Osteochondral defects of the femoral head are exceedingly rare, with limited treatment options. Restoration procedures for similar defects involving the knee and ankle have been well described. In this report, we present a young patient who had a symptomatic osteochondral defect of the femoral head develop secondary to trauma and underwent subsequent treatment using a fresh-stored osteochondral allograft via a trochanteric osteotomy. At the 1-year followup, the patient was symptom free with near-complete incorporation of the graft radiographically. Our observations in this case suggest osteoarticular implantation may be an appropriate alternative to consider when treating osteochondral defects of the femoral head.


  1. 1.
    Akimau P, Bhosale A, Harrison PE, Roberts S, McCall IW, Richardson JB, Ashton BA. Autologous chondrocyte implantation with bone grafting for osteochondral defect due to posttraumatic osteonecrosis of the hip: a case report. Acta Orthop. 2006;77:333–336.CrossRefPubMedGoogle Scholar
  2. 2.
    Aubin PP, Cheah HK, Davis AM, Gross AE. Long-term followup of fresh femoral osteochondral allografts for posttraumatic knee defects. Clin Orthop Relat Res. 2001;391(suppl):S318–S327.CrossRefPubMedGoogle Scholar
  3. 3.
    Ball ST, Amiel D, Williams SK, Tontz W, Chen AC, Sah RL, Bugbee WD. The effects of storage on fresh human osteochondral allografts. Clin Orthop Relat Res. 2004;418:246–252.CrossRefPubMedGoogle Scholar
  4. 4.
    Beaver RJ, Mahomed M, Backstein D, Davis A, Zukor DJ, Gross AE. Fresh osteochondral allografts for post-traumatic defects in the knee: a survivorship analysis. J Bone Joint Surg Br. 1992;74:105–110.PubMedGoogle Scholar
  5. 5.
    Belal MA, Reichelt A. Clinical results of rotational osteotomy for treatment of avascular necrosis of the femoral head. Arch Orthop Trauma Surg. 1996;115:80–84.CrossRefPubMedGoogle Scholar
  6. 6.
    Buckwalter JA. Evaluating methods of restoring cartilaginous articular surfaces. Clin Orthop Relat Res. 1999;367(suppl):S224–S238.CrossRefPubMedGoogle Scholar
  7. 7.
    Bugbee WD. Fresh osteochondral allografts. J Knee Surg. 2002;15:191–195.PubMedGoogle Scholar
  8. 8.
    Clanton TO, DeLee JC. Osteochondritis dissecans: history, pathophysiology and current treatment concepts. Clin Orthop Relat Res. 1982;167:50–64.PubMedGoogle Scholar
  9. 9.
    Espinosa N, Beck M, Rothenfluh DA, Ganz R, Leunig M. Treatment of femoro-acetabular impingement: preliminary results of labral refixation: surgical technique. J Bone Joint Surg Am. 2007;89(suppl 2 pt.1):36–53.CrossRefPubMedGoogle Scholar
  10. 10.
    Ghazavi MT, Pritzker KP, Davis AM, Gross AE. Fresh osteochondral allografts for post-traumatic osteochondral defects of the knee. J Bone Joint Surg Br. 1997;79:1008–1013.CrossRefPubMedGoogle Scholar
  11. 11.
    Gole MD, Poulsen D, Marzo JM, Ko SH, Ziv I. Chondrocyte viability in press-fit cryopreserved osteochondral allografts. J Orthop Res. 2004;22:781–787.CrossRefPubMedGoogle Scholar
  12. 12.
    Gortz S, Bugbee WD. Fresh osteochondral allografts: graft processing and clinical applications. J Knee Surg. 2006;19:231–240.PubMedGoogle Scholar
  13. 13.
    Guilleminet M, Barbier JM. Osteochondritis dissecans of the hip. J Bone Joint Surg Br. 1957;39:268–277.PubMedGoogle Scholar
  14. 14.
    Hall FM. Osteochondrosis dissecans and avascular necrosis of bone. (Comment on: Skeletal Radiol. 1990;19(6):419–421.) Skeletal Radiol. 1991;20:272.Google Scholar
  15. 15.
    Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am. 1969;51:737–755.PubMedGoogle Scholar
  16. 16.
    Hart R, Janecek M, Visna P, Bucek P, Kocis J. Mosaicplasty for the treatment of femoral head defect after incorrect resorbable screw insertion. Arthroscopy. 2003;19:E1–E5.PubMedCrossRefGoogle Scholar
  17. 17.
    Jeng CL, Kadakia A, White KL, Myerson MS. Fresh osteochondral total ankle allograft transplantation for the treatment of ankle arthritis. Foot Ankle Int. 2008;29:554–560.CrossRefPubMedGoogle Scholar
  18. 18.
    LaPrade RF, Botker J, Herzog M, Agel J. Refrigerated osteoarticular allografts to treat articular cartilage defects of the femoral condyles: a prospective outcomes study. J Bone Joint Surg Am. 2009;91:805–811.CrossRefPubMedGoogle Scholar
  19. 19.
    Linden B, Jonsson K, Redlund-Johnell I. Osteochondritis dissecans of the hip. Acta Radiol. 2003;44:67–71.CrossRefPubMedGoogle Scholar
  20. 20.
    Lindholm TS, Osterman K, Vankka E. Osteochondritis dissecans of elbow, ankle and hip: a comparison survey. Clin Orthop Relat Res. 1980;148:245–253.PubMedGoogle Scholar
  21. 21.
    Mahomed MN, Beaver RJ, Gross AE. The long-term success of fresh, small fragment osteochondral allografts used for intraarticular post-traumatic defects in the knee joint. Orthopedics. 1992;15:1191–1199.PubMedGoogle Scholar
  22. 22.
    Morag G, Kulidjian A, Zalzal P, Shasha N, Gross AE, Backstein D. Total knee replacement in previous recipients of fresh osteochondral allograft transplants. J Bone Joint Surg Am. 2006;88:541–546.CrossRefPubMedGoogle Scholar
  23. 23.
    O’Driscoll SW. The healing and regeneration of articular cartilage. J Bone Joint Surg Am. 1998;80:1795–1812.PubMedGoogle Scholar
  24. 24.
    Pearsall AW 4th, Tucker JA, Hester RB, Heitman RJ. Chondrocyte viability in refrigerated osteochondral allografts used for transplantation within the knee. Am J Sports Med. 2004;32:125–131.CrossRefPubMedGoogle Scholar
  25. 25.
    Rijnen WH, Lameijn N, Schreurs BW, Gardeniers JW. Total hip arthroplasty after failed treatment for osteonecrosis of the femoral head. Orthop Clin North Am. 2009;40:291–298.CrossRefPubMedGoogle Scholar
  26. 26.
    Rowe SM, Moon ES, Yoon TR, Jung ST, Lee KB, Lee JJ. Fate of the osteochondral fragments in osteochondritis dissecans after Legg-Calve-Perthes’ disease. J Bone Joint Surg Br. 2002;84:1025–1029.CrossRefPubMedGoogle Scholar
  27. 27.
    Schenck RC Jr, Goodnight JM. Osteochondritis dissecans. J Bone Joint Surg Am. 1996;78:439–456.PubMedGoogle Scholar
  28. 28.
    Schneider W, Aigner N, Pinggera O, Knahr K. Intertrochanteric osteotomy for avascular necrosis of the head of the femur: survival probability of two different methods. J Bone Joint Surg Br. 2002;84:817–824.CrossRefPubMedGoogle Scholar
  29. 29.
    Shasha N, Krywulak S, Backstein D, Pressman A, Gross AE. Long-term follow-up of fresh tibial osteochondral allografts for failed tibial plateau fractures. J Bone Joint Surg Am. 2003;85(suppl 2):33–39.PubMedGoogle Scholar
  30. 30.
    Sheng PY, Konttinen L, Lehto M, Ogino D, Jamsen E, Nevalainen J, Pajamaki J, Halonen P, Konttinen YT. Revision total knee arthroplasty: 1990 through 2002. A review of the Finnish arthroplasty registry. J Bone Joint Surg Am. 2006;88:1425–1430.CrossRefPubMedGoogle Scholar
  31. 31.
    Springer BD, Connelly SE, Odum SM, Fehring TK, Griffin WL, Mason JB, Masonis JL. Cementless femoral components in young patients: review and meta-analysis of total hip arthroplasty and hip resurfacing. J Arthroplasty. 2009 June 23. [Epub ahead of print].Google Scholar
  32. 32.
    Williams SK, Amiel D, Ball ST, Allen RT, Wong VW, Chen AC, Sah RL, Bugbee WD. Prolonged storage effects on the articular cartilage of fresh human osteochondral allografts. J Bone Joint Surg Am. 2003;85:2111–2120.PubMedGoogle Scholar

Copyright information

© U.S. Government 2009

Authors and Affiliations

  1. 1.Integrated Department of Orthopaedics and RehabilitationWalter Reed National Military Medical CenterBethesdaUSA

Personalised recommendations