I'm looking into different options for my hip pain. I know I have funny shaped hip bones so the joint rubs wrong and has caused a hole to form in the hip socket. I don't want to have a hip replacement just yet. I did find some information on your website about treatment for these kinds of holes in the knee. Can they do the same thing for 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. As you have seen, this technique has been used for the knee.
There have been a couple of small studies reporting results from using this same technique with the hip. Specifically, microfracture was used with full-thickness acetabular cartilage defects.
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. This might be similar to your situation as you described your problem as a "funny-shaped" hip.
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.
There aren't very many studies reporting the results of using microfracture for hip osteochondral lesions. We found two studies that have been published. The surgeons evaluated the effectiveness of the microfracture treatment by performing a second arthroscopic examination some time later.
In one study of 20 patients with osteochondral lesions associated with femoroacetabular impingement, all but one patient had a good result. The repair tissue was rated as "good quality" and filled 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.
In the second study, there were only nine patients but again, 95 per cent fill-in. There have been many other patients who have had this procedure but not with a second-look follow-up arthroscopic examination to see the actual results.
The evidence so far suggests that microfracture for acetabular (hip) cartilage lesions can produce good results. This procedure can 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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