Boy (12) becomes first in Ireland to have pioneering hip procedure

A 12-year-old boy has become the first person in Ireland to undergo a new transplant procedure to replace a damaged hip joint using a donor femoral head bone and cartilage.

The OFHAT procedure involves replacing the bone and cartilage surface on the femoral side of the hip joint with donor bone and cartilage.

Before the procedure, the usual option for children who suffered AVN has been hip fusion or hip replacement. Hip replacement often requires revision surgery after 10 years and further revision surgery is eventually not possible due to bone loss or infection.

In children of 10 or 11 years of age, hip replacement will have poor results in the long term requiring multiple revisions over their lifetime .

Explaining the OFHAT (osteochondral femoral head allograft transplantation) procedure, Dr Green said the size and shape of the child’s femoral head is mapped on MRI and they then go on a recipient waiting list .

Once there is a size match, surgery can proceed involving the hip being dislocated from the socket and the damaged cartilage and bone removed.

The shape of the removed bone is measured and the donor femoral head is used to replace the empty space. The result is the child has a biologic hip instead of an artificial hip replacement and it helps with their pain.

Click here to read the entire article, which is posted by The Irish Times.

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Former College Athlete Gives Unique Perspective on Knee Cartilage Injury

Image result for knee injury pics

It was a typical winter afternoon in southern California playing with his son at the park.

He stepped in a small hole, not unlike a hundred times before in the past without incident, so he brushed it off as just a temporary tweak or mild sprain. He then did a quick jog to the car and noticed a pinch of pain on the outside of his knee with every step forcing him to stop and walk.

Joshua grew up in Southern California playing about every sport imaginable sometimes playing hockey and football games in the same day. He was a varsity four sport athlete in high school, at one point even training with future professional Olympic and elite spartan runners running up ski slopes at the local resorts. In college, he ran under a coach who was an American record holder in the mile. No matter what sport or how many thousands of miles in training, he never suffered any major injuries.

The day after rolling his ankle he noticed he could not quite bend his knee as much and then when playing with his one-year old daughter his knee suddenly locked for a few minutes unable to straighten or bend at all. In the next couple days, Joshua was able to get a stat MRI.

He did know that since college he had put on about five pounds a year and this raised the risk of him having a knee injury or potentially damaging his cartilage.  With his ten years of experience as a Physicians Assistant (PA) in Orthopedic Surgery specializing in sports medicine, he started speculating on his diagnosis – quite possibly a bucket handle meniscus tear.

What he saw on the MRI scan immediately shocked him. He could see clearly that he had sheared off a chunk of his articular cartilage the size of a dime, which looked like a snow plow went through it. “I knew I was in big trouble,” Joshua explains, “…it’s such a bad injury because cartilage does not heal itself and doesn’t regenerate.”

Being dealt this curveball, Joshua started immediately reviewing and researching more about current cartilage surgeries to make the best decision on how to get it treated. Coincidentally, ten years earlier, while going through his graduate PA program, he chose as his master’s project “new treatment strategies in knee injuries for the prevention of knee arthritis.” As a PA in Orthopedic Surgery, he had scrubbed about a dozen cases throughout his ten-year career and knew the complexity of cartilage surgeries. After weighing the pros and cons, he eliminated a possible autograft or microfracture. He reached out to a renowned sports Orthopedic surgeon, Dr. Raffy Mirzayan, about performing a cartilage allograft transplantation.

A few months after the injury and finding a right match, Joshua went through with the two-hour outpatient surgery with no complications. Within six weeks he was walking with a cane and had full range of motion. Now, at five months after the surgery, he can walk normally and go up and down stairs; perhaps most importantly, he is able to play with is two kids again. His hope is to get back to running once his knee has healed (after about eight months) and to get back to running with his competitive college teammates.

He is eternally grateful to the donor and the family and he wants to do something special before he reaches out to them to thank them for the gift of donation. “I really enjoy helping others… I want to be able to pay it forward.

“I haven’t written a letter yet because I want to do something to thank them… I want to write a letter with me doing something (finishing a race) to show them how much of an impact it made for me.”

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Bipolar Osteochondral Allograft Transplantation of the Patella and Trochlea

Purpose: To evaluate the outcomes of bipolar osteochondral allograft (OCA) transplantation in the patellofemoral joint.

Summary:

  • Limited studies are available pertaining to OCA transplantation in the patellofemoral joint, especially on bipolar OCAs to both the patella and trochlea
  • Follow-up was obtained on 15 knees that underwent a combined OCA transplant to address either trochlear dysplasia with patellofemoral instability or high grade chondral lesions
  • OCA plugs were harvested from patella and trochlear grafts from the same donor to provide a congruent anatomic surface
  • At an average follow-up of 33.2 months, significant functional improvements were observed in KOOS, IKDC, Tegner, Oxford, Cincinnati, VAS and SANE scores
  • While two patients did require further surgery to address postoperative stiffness and lysis of adhesions, no patient needed revision or conversion to arthroplasty and there were no patellar re-dislocations

JRF Ortho Take Away: While previous studies have shown that OCA transplantation to the patellofemoral joint can have an increased risk of failure compared to other areas of the knee, bipolar OCA transplantation to the patella and trochlea using tissue from the same donor can be a good option. At short to mid-term follow-up, this technique demonstrated significant improvement for recurrent dislocation and high grade chondral lesions.

Click here for the abstract or full article.

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Knee Cartilage Transplant Video Performed by Orthopedic Surgeon Dr. Brian Cole

After a string of serious knee injuries, Mark, a 19-year-old college football player, faces an uncertain future playing the game he loves. In addition to the emotional toll the injuries have taken, Mark also endures unbearable knee pain.

To repair his knee, Mark undergoes a breakthrough knee cartilage transplant, performed by orthopedic surgeon Dr. Brian Cole, the Chicago Bulls’ team physician.

Do you want to learn more about knee cartilage transplantation? Click here to watch Dr. Cole on “The Doctors” treat a young college football player using this breakthrough surgery.


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