PMC7607946_01
(a, b) Preoperative plain anteroposterior radiograph showing trochanteric overgrowth, short femoral neck, sagging rop sign (white arrow). (c) Coronal computed tomography scan indicating superolateral chondral defect. (d) Coronal magnetic resonance imaging showing unstable superolateral chondral fragment (white arrow).
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F1
The femoral neck was short and trochanteric overgrowth was noted (Figure 1a, b). Computed tomography and magnetic resonance imaging (MRI) scans confirmed the osteochondral lesion located on the superolateral and central part of the femoral head (Figure 1c, d).
(a) Intraoperative picture of femoral head showing (white arrow) chondral defect. (b) Autografts were harvested from anterior-inferior part of femoral head. (c) Defect was replaced with five 8 mm and one 6 mm autografts. (d) Femoral head was reshaped and stable trochanteric fragment was trimmed away.
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F2
Approximately 2x3 cm chondral lesion of the femoral head was confirmed intraoperatively (Figure 2a). Anterolateral aspect of aspheric femoral head which was planned to be removed to improve femoral head morphology was used for graft harvesting (Figure 2b). Osteochondral autograft transplantation was performed with six plugs (five 8 mm and one 6 mm; DePuy osteochondral autograft transplantation system, DePuy Mitek Inc., Raynham, Massachusetts, USA) (Figure 2c). Next, the femoral head-neck junction was debrided utilizing osteotomes and a high- speed burr to improve offset (osteochondroplasty) (Figure 2d). After the flap was composed, posterosuperior part of the stable trochanter was trimmed away until the level of the superior femoral neck (Figure 2d).
Postoperative immediate (a) and sixth-month follow-up (b) plain radiographs showing relative neck lengthening and healed trochanter major.
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F3
With trochanteric advancement, improvement of abductor lever arm along with relative femoral neck lengthening was accomplished (Figure 3).
(a, b) Magnetic resonance imaging of right hip after 18 months indicates a descent integration of plugs and slight chondral step-off. (c) Axial plane section shows bone plugs used for mosaicplasty.
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F4
After 18 months of follow- up, control MRI of the right hip indicated integration of the osteochondral plugs with no significant femoral head step-off (Figure 4).