Transfer of osteochondral shell autografts to salvage femoral head impaction injuries in hip trauma patients.

Hanke, Markus S.; Keel, Marius J.B.; Cullmann, Jennifer L.; Siebenrock, Klaus A.; Bastian, Johannes D. (2020). Transfer of osteochondral shell autografts to salvage femoral head impaction injuries in hip trauma patients. Injury - international journal of the care of the injured, 51(3), pp. 711-718. Elsevier 10.1016/j.injury.2020.01.037

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Femoral head impaction defects are observed with variable severity, as a result of traumatic hip dislocations which can be caused by traffic accidents or seen in professional athletes amongst other mechanisms. Compression of the articular cartilage and the subchondral bone into the femoral head results in irregular articular surfaces influencing the outcome with predisposition to osteoarthritis, and being predictive for the need for delayed total hip replacement. This study reports the outcome after a minimum follow-up (FU) of five years in a consecutive series treated with transfer of osteochondral shell autografts in hips (TOSAH) from the head-neck junction into the defect using surgical hip dislocation.


Between 06/2007 and 03/2014 a series of twelve consecutive patients (mean age: 35yrs, range 18-53; median Injury Severity Score: 12, range 9-27) sustained a traumatic posterior hip dislocation in combination with acetabular and/or Pipkin fractures and were inter alia treated using TOSAH using surgical hip dislocation. Conversion to total hip replacement (THR) during FU was noted as failure. Patients were clinically (Merle d'Aubigné score) and radiographically assessed for occurrence of osteoarthritis (OA), avascular necrosis (AVN) and/or heterotopic ossification (HO) at a minimal follow-up of five years.


Mean follow-up was 6.9 years (5.0-11.6). At five-year follow-up, we found a survivorship of 57.1% (95% Confidence interval {CI}, 46.7-100%). Four patients required conversion to a total hip replacement at 11, 16, 28 and 44 months respectively after the TOSAH procedure due to osteoarthritis progression. One patient required conversion to a total hip replacement 12 months after TOSAH procedure due to AVN. One patient was lost to follow-up after 2.7 years. The remaining six patients with preserved hips presented with a median Merle-d'Aubigné score of 16 points (range: 14-18) and no AVN. Two patients showed asymptomatic grade I osteoarthritis according to Tönnis at latest follow-up and three patients showed mild asymptomatic HO according to Brooker (Grade I-II).


The presented technique can be used as a salvage procedure for severely injured hip joints and to preserve the hip joint at midterm with satisfying clinical and radiological outcomes.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Department of Orthopaedic, Plastic and Hand Surgery (DOPH) > Clinic of Orthopaedic Surgery
04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic, Interventional and Paediatric Radiology

UniBE Contributor:

Hanke, Markus (B), Keel, Marius, Cullmann, Jennifer, Siebenrock, Klaus-Arno, Bastian, Johannes Dominik


600 Technology > 610 Medicine & health








Maria de Fatima Henriques Bernardo

Date Deposited:

18 Feb 2020 14:58

Last Modified:

29 Mar 2023 23:37

Publisher DOI:


PubMed ID:


Uncontrolled Keywords:

Femoral head impaction Femoral head injury Osteochondral transplantation Salvage procedure Surgical hip dislocation Traumatic hip dislocation




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