Name: Case Spotlight: Use of Fresh Osteochondral Allograft in the Femoral Head
Uploaded: 2026-08-31T12:08:00Z
Channel: Arthrex
Description: Ishvinder S. Grewal, MD (Dallas, TX), presents a case in which a traumatic hip fracture resulted in a large osteochondral defect. Dr. Grewal shares why an osteochondral allograft was selected as a viable option for this patient profile and procedure.

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Trauma Lower Extremities

Ishvinder S. Grewal, MD (Dallas, TX), presents a case in which a traumatic hip fracture resulted in a large osteochondral defect. Dr. Grewal shares why an osteochondral allograft was selected as a viable option for this patient profile and procedure.

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VID1-007883-en-US | A | Case Spotlight: Use of Fresh Osteochondral Allograft in the Femoral Head

Ishvinder S. Grewal, MD

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Case Spotlight: Use of Fresh Osteochondral Allograft in the Femoral Head

Speaker  Hi. My name is Doctor Grewal. I am a orthopedic trauma reconstruction surgeon based out of Dallas, Texas, and mainly focusing on pelvic acetabula and hip surgery. And I will be presenting a case today on the use of Osteochondral allograft for the treatment of femoral head fractures with marginal impaction. The case will be presented today is a 36 year old male tourist. He is a software engineer who was vacationing from Bogota, Colombia, and was unfortunately involved in a high speed MVC. He was a restrained rear seat passenger and presented with left hip pain and inability to weight bear. He has no significant past medical history and is of average build six foot tall, £183. So if we look here at the injury imaging, he has this large anterior femoral head fracture which is displaced, as well as this marginal impaction right of the weight bearing dome. This is again displayed nicely on the axial, coronal and sagittal reconstructions. We can see this displaced anterior fracture as well as this large defect right at the weight bearing dome. Now options for treatment. If this was just the femoral head fracture alone without the marginal impaction. This would be a fairly routine orif with an anterior or approach or a surgical hip dislocation. Now, with that large area of marginal impaction treatment options become more challenging, we can either do nonoperative treatment, preserve the native soft tissue planes, and then come back and perform arthroplasty for the inevitable arthritic changes he's likely to develop, probably fairly rapidly. Operatively we can again perform anterior approach or surgical hip dislocation, perform an RAF that will address the large anterior fragment, which is really not going to do anything to address the marginal impaction of the weight bearing dome, we could perform delayed arthroplasty, wait 6 to 12 weeks, let everything settle down soft tissue wise, and perform a hip replacement. Speaker  This comes with the issues of patient being relatively young and requiring one, potentially two revisions in his lifetime. Option three would be to perform an acute arthroplasty. However, evidence does show that acute arthroplasty in trauma has a higher complication rate than elective arthroplasty for arthritis. And again, in a patient of younger age is a significant consideration. And finally this brought me to the last option fresh osteochondral allograft transplantation. Now this really came about from coffee discussions with my partners who work in the young adult hip field, who often use Osteochondral allograft for treating small sports related osteochondral defects. Having talked about this, I had a look at the literature and there's a couple of cases reported out of HSS, as well as one case reported by Baumgartner as well. So case considerations really this is for a femoral head fracture without weight bearing zone marginal impaction which doesn't really have any good treatment options currently. It does require a good healthy host and someone who is theoretically too young for arthroplasty. Preoperative planning. We opted to perform the Osteochondral allograft. We placed the patient lateral on a radiolucent table with a radiolucent beanbag, performed a standard surgical hip dislocation with a trochanteric osteotomy, and having measured the CT scan from the injury films, I approximated the defect to be approximately 12mm square, so I requested 212mm ossias in case the defect was larger than expected. Speaker  Sometimes the issue with 3D imaging is you're looking at three different slices, and it can underestimate the overall size of a defect. Technique. Here we go from the standard surgical application. And we can see the anterior fragment as well as the depressed area superiorly. Perform the routine RAF fracture was reduced held with pointed reduction forceps and then fixed with headless compression screws. Now what's interesting is now we've reduced the fracture. You can see actually the weight bearing dome lesion is significantly larger. Now the rest of the anterior femoral head is in its correct position. So therefore I use two plugs as requested and then filled in the gaps with BioCartilage per the OptiFit technique. You can use these without screws. But as generally when you're putting the plugs into a confined defect, in this case, because there wasn't a rim fit, I fixed them with a headless compression screws and we're already using those to fix the other fracture. And it's also quite reassuring when we drill through this and get bleeding from the bone to kind of confirm the viability of the femoral head. Here we have intraoperative fluoroscopy, which shows fixation of the osteotomy, as well as good reduction in circumferential views of the femoral head. The most important view, I think, though, is if you come right around to the far side here, we see this still apparent area of defect at the superior lateral border, where the screws look prominent. However, in reality, clinically they're not prominent. They're flush with the cartilage. And this is where the cartilage is not visible on radiographs. And so this is really important when looking at the follow up imaging as this appearance is maintained throughout his follow up. Speaker  Here we have post-operative CT scans showing good reduction of the fracture, good filling in of that large marginal impaction region and good reduction of fixation of the trochanteric osteotomy. We can see a significantly improved from pre-operatively post-operative protocol. I kept the patient toe touch weight bearing for 12 weeks with an assisted device, and he's following up with an orthopedic surgeon in Bogota, and currently he's been walking fully weight bearing for two months. He has no assistive device and no pain, and he's doing very well. And there's no significant degenerative changes in the hip. Looking back at the case, I requested the pre-cut cores because they're readily available, and I felt the defect was amenable to filling in with them. With hindsight, I'd have probably used a fresh femoral head. What I really learned from this case was the defect that you see on a CT is often larger intraoperatively, and the benefit of femoral head is you can really get flexibility with the sizing of it. And the contouring is much easier as well. You could also potentially then do this without screws if you've got an interference fit. I would certainly suggest always having BioCartilage on hand for filling any gaps. Having learnt now, I would probably have placed some SutureTape initially underneath the graft so that as I was impacting it, if I over impacted it, which fortunately didn't happen, it would be easier to remove and back it out if required. Thank you for listening and I hope this has been beneficial to you.

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Case Spotlight: Use of Fresh Osteochondral Allograft in the Femoral Head

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