Arthroscopic three-dimensional autologous chondrocyte transplantation using spheroids for the treatment of full-thickness cartilage defects of the hip joint.

ABSTRACT

PURPOSE: Treatment of full-thickness cartilage defects in the hip is a major issue for orthopaedic surgeons. Autologous matrix-induced three-dimensional chondrocyte transplantation using three-dimensional spheroids (ACT 3D) may be an option for treatment. The aim of the study is to describe the feasibility and first clinical results of ACT 3D with spheroids at the hip. METHODS: In this report, the surgical technique was described for the first time, and the outcome of sixteen patients with chondral defects induced by cam-type femoroacetabular impingement (FAI) who were followed up in a prospective study was evaluated. All patients underwent physical examination before the first surgery and again before the second (about 6 weeks later). Further examinations were performed 6 weeks after the second surgery and at an average follow-up period of 16.09 months. At every visit, the non-arthritic hip score (NAHS) and the Western Ontario and McMaster Universities Arthritis Index (WOMAC) were obtained. In addition, patient satisfaction was evaluated during the last follow-up examination by means of a questionnaire. RESULTS: The NAHS and WOMAC scores had significantly improved 6 weeks after arthroscopic treatment of the cam-type FAI, and a further significant enhancement was seen 6 weeks after the second surgery with application of the chondrocyte spheroids. In the last follow-up, the mean results were equally as good as the second follow-up examination 12 weeks after surgery. CONCLUSIONS: The present study shows that ACT 3D using spheroids is a feasible method that can be easily performed during arthroscopy. As the first results have been encouraging, the ACT 3D with spheroids at the hip should be continued. More studies should be initiated to get an impression of the quality grade of this method in comparison with other treatment options in case of chondral defects at the hip. LEVEL OF EVIDENCE III.