Femoral head-neck junction reconstruction, after iatrogenic bone resection

Abstract

Arthroscopic over-resection of the head-neck junction during the treatment of a cam deformity can be a devastating complication and is difficult to treat. Large defects of the femoral head-neck junction (FHNJ) increase the risk of femoral neck fracture and can also affect hip biomechanics. We describe a case of an iatrogenic defect of the FHNJ due to excessive bone resection, and a previously non-described treatment using iliac crest autograft to restore femoral head-neck sphericity and hip joint stability. After protecting the femoral neck with an angled blade plate, the large anterior FHNJ defect was reconstructed using autogenous iliac crest bone graft; sphericity was restored by contouring the graft using spherical templates. Clinical and radiographic follow-up was performed up to 2 years. Results at 2 years showed no residual groin pain and normal range of motion. The Oxford Hip Score was 46/48, rated as excellent. Computed tomography (CT) scanning showed union of bone graft without resorption, and CT arthrogram indicating retained sphericity of the FHNJ without evidence of degenerative changes in the articular surface. This novel surgical technique can be used to restore the structural integrity and contour of the FHNJ that contains a significant anterior defect.