PMC6906870_01
(a) Anteroposterior plain radiograph of the left hip demonstrating a femoral head deformity laterally (white arrow) with no signs of osteoarthritis. (b) Lateral plain radiograph demonstrating normal morphology of the femoral head with no signs of osteoarthritis. (c) Three-dimensional reconstruction of the pelvis (blue) and proximal femur (gold) with superimposed spherical virtual femoral head (orange) demonstrating the area of missing bone on the lateral femoral head (black arrow).
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This demonstrated a global absence of bone on the lateral aspect of the femoral head. (Figures 1(a) and 1(b)). A three-dimensional virtual plan was created to delineate the exact area of hypoplasia in planning the allograft procedure (Figure 1(c)).
PMC6906870_02
(a) Intraoperative photograph demonstrating guidepins placed in the lateral femoral head defect prior to coring for osteochondral allografting. The white arrowhead shows the anterior extent of the lateral femoral head lesion. (b) Intraoperative photograph demonstrating osteochondral allografts restoring the lateral contour of the femoral head at the side of the lateral femoral head defect. The central graft (black arrow) is in the process of being fully seated. (c) Intraoperative photograph of the femoral head apex with a 25 mm osteochondral allograft (white arrow) stabilized by two PLLA pins. (d) Immediate postoperative AP hip radiograph after femoral head osteochondral allografting through a trochanteric osteotomy with 2 metal screws holding the lateral femoral grafts in place. The apical femoral head graft is demonstrated by the white arrow.
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The area of lateral femoral head hypoplasia was immediately proximal to the MFCA (Figure 2(a)) with three grafts being placed proximal to the entry site of the MFCA into bone. A total of 3 grafts were placed in the lateral femoral head and interlocked in a "snowman" configuration such that the edge of the peripheral grafts was removed to accommodate the central most graft (Figure 2(b)). In the superior dome, a 25 mm core graft was obtained from the donor's femoral head and implanted, leading to a smooth surface of the articular cartilage (Figure 2(c)).