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

UNLABELLED: 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.

LEVEL OF EVIDENCE: Therapeutic Level V. See Instructions for Authors for a complete description of levels of evidence.