Autologous chondrocyte implantation for hip osteochondritis functioning 15 years after operation

Abstract

<b>Background:</b> The autologous implantation technique (ACI) was first introduced in studies on cartilage defects in knees. It has later been used for the treatment of osteochondral knee lesions. The patient presented here had a hip osteochondral defect measuring 4 cm in diameter. He was a candidate for hip prosthesis because of serious pain and reduced function. Being young and highly motivated for alternatives to prosthesis he was to our knowledge the first patient treated with ACI to the hip in 1999.<br> <b>Methods:</b> Autologous chondrocytes obtained from knee cartilage biopsies were grown at a laboratory in Gothenburg. The operation was done at The University Hospital North Norway where removal of damaged cartilage and loose bony fragments was done on an operatively luxated hip. In the cleaned area implantation of chondrocytes under a periosteal covering was done. Gradual increased weight bearing was allowed postoperatively.<br> <b>Results:</b> Immediately postoperatively the patient reported significant relief of pain, and in the period of more than 15 following years he generally estimated pain to be 70 % reduced from the preoperative value. Frequent MR examinations the first postoperative year showed gradual filling of the defect in bone and cartilage. Contrast MRI at 22 months depicted the surface of the repaired area quite smooth. At the last control more than 15 years following ACI he reported limited pain, walked without a limp; and moderate osteoarthritis seen previously had developed further. Knowing the result, he was happy to have gone through the procedure.<br> <b>Conclusion:</b> The patient has gained more than fifteen prosthesis-free years because of the ACI operation. Quite normal cartilage adjacent to the large defect was carrying weight, and the repair area was not destroyed, as probably would have been the case in osteoarthritis. A success on the various attempts to produce normal cartilage in vitro, able to carry some weight immediately after implantation, could in the future open up for improved biological treatment of large defects, both chondral and osteochondral, in hip and knee.