A 12-year-old boy has become the first person in Ireland to undergo a new transplant procedure to replace a damaged hip joint using a donor femoral head bone and cartilage.
The child was in acute pain for almost a year before the surgery was carried out last week and was unable to walk, go to school or sleep properly.
After Connor Green, consultant paediatric orthopaedic surgeon at the Children's University Hospital, Temple Street, carried out the surgery on September 11th, the boy told him the acute pain was gone and he had waved the delighted child off last weekend with paracetamol only.
The boy will have to remain on crutches for three months to allow for a healing process after which he “will hopefully be able to get back to school and to his childhood”.
Mr Green learned how to do the osteochondral femoral head allograft transplantation (OFHAT) surgery while training at a not-for-profit children's hospital in Dallas, Texas.
Training
A son of professional club golfer Seamus Green, he pursued medicine at UCD and orthopaedic training at the Royal College of Surgeons before deciding to specialise in paediatric orthopaedics and pursue further training in the United States.
He returned to Temple Street two years ago and is the only person in Ireland trained to do the complex two-stage procedure.
He praised the staff and management of Temple Street, including endocrinologist Dr Ciara McDonnell, for their assistance with and support for the surgery.
Temple Street is one of very few hospitals worldwide able to provide the procedure, which could help other adults and children as it is a better and ultimately cheaper alternative to hip replacements, he said.
The long-term follow-up is as yet unknown but hopefully the boy’s new hip “will last forever”.
After a suitable donor was sourced in the US, the transplant operation had to be carried out within a week. The only disclosable information on the donor is she is female. Female hips are generally more suitable for children.
The boy had a fall in October 2017 causing a slipped femoral epiphysis, a fracture through the growth plate which results in slippage of the joint surface at end of the femur.
Despite surgeries in another hospital aimed at stopping avascular necrosis (AVN) of the bone, effectively bone death due to loss of blood supply, the child ultimately suffered complete necrosis or degeneration of the head of the femur, the main hip bone, and the head was moving out of the joint.
This collapse leads to cartilage collapse and painful arthritis.
The boy was referred to Dr Green at Temple Street where the specialist’s initial aim was to put the hip back in the correct position and get the AVN to heal.
He did that by putting the child in an external fixator, an external scaffold on the leg, and injecting stem cells into the dead area.
Once the bone had healed, the scaffold was removed but, because the necrosis had completely destroyed the cartilage, either a hip replacement or transplant was required.
Procedure
The OFHAT procedure involves replacing the bone and cartilage surface on the femoral side of the hip joint with donor bone and cartilage.
Before the procedure, the usual option for children who suffered AVN has been hip fusion or hip replacement. Hip replacement often requires revision surgery after 10 years and further revision surgery is eventually not possible due to bone loss or infection.
In children of 10 or 11 years of age, hip replacement will have poor results in the long term requiring multiple revisions over their lifetime .
Explaining the OFHAT procedure, Dr Green said the size and shape of the child’s femoral head is mapped on MRI and they then go on a recipient waiting list .
Once there is a size match, surgery can proceed involving the hip being dislocated from the socket and the damaged cartilage and bone removed.
The shape of the removed bone is measured and the donor femoral head is used to replace the empty space. The result is the child has a biologic hip instead of an artificial hip replacement and it helps with their pain.
