First-Person Long-term Follow-up Using Autologous Mosaicplasty for Osteochondral Lesion Accompanying Femoral Head Fracture.

Abstract

I present my perspective as a patient and surgeon on complete functional recovery after a devastating hip injury. This report represents the longest follow-up in the literature for autologous osteochondral mosaicplasty to treat an osteochondral defect associated with a femoral head fracture. I was 21 years old when I fractured my hip in a skiing accident. Days after immediate reduction, arthroscopy was attempted but converted to open reduction internal fixation with osteochondral autograft for a type II Pipkin fracture and associated osteochondral injury. Joint preservation was intended to delay hip replacement that was forecasted within a decade given the extent of disease. Thirteen years later, I remain pain-free with a Harris hip score of 100. I perform surgery daily and enjoy long-distance running despite radiographic follow-up at 8 years that demonstrated evolving degenerative change. Because of the incongruity of pain, function, and radiologic findings, I hesitate to obtain additional imaging. I prefer to remain ignorant of the radiologic status of my hip joint, relying instead on prospective pain and impairment. My experience illustrates that full recovery and return-to-sport can be achieved and persist for years. The relevance of imaging after joint preservation surgery is questionable in the absence of symptoms. Therapeutic Level V. See Instructions for Authors for a complete description of levels of evidence.