Microfracture: Good For the Knee but What About the Hip?Defects, holes, or lesions of the articular cartilage (surface of the joint) can be treated with a surgical procedure known as microfracture. The surgeon creates tiny holes in the surface of the joint at the site of the problem area. Blood seeps through from the bone marrow and stimulates a healing response. This technique has been used for the knee but can it be just as useful for the hip?
That's what the authors of this study set out to find out. They treated 20 patients with full-thickness acetabular cartilage defects with microfracture. Full-thickness means the damage done to the surface of the joint went clear down to the bone underneath. These are called osteochondral lesions. Acetabular refers to the acetabulum, the hip socket. In each case, the reason the patients all had this type of damage was because of a condition known as femoroacetabular impingement or FAI.
Femoroacetabular impingement (FAI) occurs in the hip joint. Impingement refers to some portion of the soft tissue around the hip socket getting pinched or compressed. Femoroacetabular tells us the impingement is occurring where the femur (thigh bone) meets the acetabulum (hip socket). There are several different types of impingement. They differ slightly depending on what gets pinched and where the impingement occurs.
Over time, this pinching or impingement of the labrum can cause fraying and tearing of the edges and/or osteochondral lesions at the impingement site. For these 20 patients, most of the defects were in the front part of the acetabulum. Treatment was advised to help decrease pain and prevent further hip degeneration.
There aren't very many studies reporting the results of using microfracture for hip osteochondral lesions so this study is an important one. The surgeons evaluated the effectiveness of the microfracture treatment by performing a second arthroscopic examination some time later (a range between 5 months and four years after the procedure).
All but one patient had a good result with repair tissue rated as "good quality" and filling in 95 per cent of the defect. The one "poor" result had only one-fourth of the lesion filled in and that with only fibrous cartilage, not true, healthy osteochondral tissue.
The authors concluded that microfracture for acetabular (hip) cartilage lesions can produce good results. This procedure should be considered for some patients with femoroacetabular impingement who develop painful osteochondral lesions. It is a simple and cost-effective surgical approach to the problem with good results.
Shanmugam Karthikeyan, MBBS, MRCS, et al. Microfracture for Acetabular Chondral Defects in Patients with Femoroacetabular Impingement. Results at Second-Look Arthroscopic Surgery. In The American Journal of Sports Medicine. December 2012. Vol. 40. No. 12. Pp. 2725-2730.
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