PMC8019562_01
Right hip obturator dislocation before (a, b) and after closed reduction (c, d).
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F1
However, a CT scan, showed an osteochondral defect on the femoral head measuring approximately 3 x 2 cm (Figure 1).
Intra-operative images of the right hip, demonstrating patient positioning (a), osteochondral lesion of the femoral head (b), femoral head after insertion of three osteochondral plugs (c, d), and filling of the non-weight-bearing surface with a screwed iliac crest autograft (e, f).
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F2
The entire surgical operation was under general anesthesia with the patient lying supine on a traction orthopedic table (Figure 2a). With this approach, we can identify the anatomical structures visually and use retractors to expose the anterolateral zone to facilitate our entry to the femoral osteochondral defect (Figure 2b). The donor plugs were transplanted by the anterolateral approach to the donor site, starting posteriorly toward the anterior area of the defect, while rotating the hip and ensuring orthogonal position both visually under traction and by using C-arm fluoroscopy. The whole procedure was carried out with caution to recreate the curvature of the femoral head and maintain the cartilage surface level (Figures 2c and 2d). An additional space resulting in the non-weight-bearing areas was filled using a cancellous bone autograft from the iliac crest; it was fixed using the AutoFIX Cannulated Screw System (AutoFIX System, Stryker) of a 4 mm diameter and 26 mm length (Figures 2e and 2f).
X-ray image of the right hip 3 months after surgery (a) left: pelvic AP, middle: right AP axial, right: external and internal oblique view (b) CT scan 1 year after surgery demonstrating both femoral head screws and a slightly irregular surface with good joint space at the upper part of the femoral head.
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F3
X-rays showed that the hip joint was in place and the femoral head was slightly curved (Figure 3a). A CT-scan after 1-year follow-up demonstrated a good integration of the osteochondral plugs with a minimal chondral step-off, and no aseptic osteonecrosis of the femoral head or hip osteoarthritis (Figure 3b).