Hip preservation is gaining in popularity as it can delay or avoid the
need for hip replacement surgery, as well as slow or reverse certain hip
conditions, such as hip impingement or femoro acetabular impingement (FAI).
Hips are prone to wear and tear and athletes are especially vulnerable
to degenerative hip disease with underlying abnormality, such as excess
bone growth and malformed sockets. In addition, osteoarthritis, which
occurs when the protective cartilage on the ends of the bones wears down
over time, can also impact hip conditions and often at a young age.
Hip pain is often the result of changes in the shape of the ball and socket
of the hip joint. Cartilage when damaged or worn away results in painful
joints and limited range of motion. New minimally invasive hip preservation
techniques can alleviate many painful hip conditions and allow people
to return to an active lifestyle.
Hip Arthroscope/Arthroscopic-assisted Hip Preservation
Your doctor may recommend hip preservation surgery if you have a painful
condition that does not respond to non-surgical treatment. Non-surgical
treatment includes rest, physical therapy, and medications or injections
that can reduce inflammation. Inflammation is one of your body's normal
reactions to injury or disease. In an injured or diseased hip joint, inflammation
causes swelling, pain and stiffness.
Patients with unexplained pain, swelling, stiffness and instability in
the hip who have had no success with non-operative treatments may undergo
hip arthroscopy for evaluation and diagnosis of their condition.
Hip arthroscopy may be indicated in following conditions
- Debridement of loose bodies
- Repair of torn labrum
- Removal of bone spurs or small CAM lesions
- Hip joint infection
- Restoration of joint morphology
Cartilage Restoration and Labral Repair
Hip preservations surgeries are also indicated in patients with early cartilage
damage and labral tear, to preserve the hip and restore its functionality.
Articular cartilage restoration and labral repair relieves pain, improves
function and can delay or prevent the onset of arthritis in the joint.
Cartilage restoration and labral repair can be achieved using different
techniques. Cartilage defects may result from an acute traumatic event
or chronic degeneration due to overuse of the hips joint. They can become
a significant cause of pain in the hip. Similarly labral tears can be
attributed to post-traumatic injuries or from primary impingement causing
significant pain. Left untreated, cartilage defects and notable labral
tears continue to worsen over time, leading to early arthritis.
Microfracture surgery: Microfracture is a procedure in which perforations of the subchondral
bone is performed and fibrocartilage growth is encouraged.
Drilling: This technique involves use of a surgical drill to make small holes through
the damaged area to penetrate the subchondral bone. This generates a healing
response within the defect.
Abrasion arthroplasty: A surgical procedure to reshape the joint by grinding down the damaged
surface typically using a rotating burr. The surgeon removes soft and
loose bits and allows blood and bone marrow cells to come to the surface
to reform a better joint surface covering.
Autologous chondrocyte implantation: ACI is a two-step procedure. First healthy cartilage tissue is removed
arthroscopically and sent to lab to be cultured and increased over about
a one-month period. The newly grown cells are implanted in the cartilage defect.
Osteochondral autograft transplantation: Healthy cartilage tissue (a graft) is taken from an area of the bone
that does not carry weight and then matched to the surface area of the
defect and impacted into place. This leaves a smooth cartilage surface
in the joint.
Osteochondral allograft transplantation: If a cartilage defect is too large for an autograft, an allograft may
be considered. Allograft tissue is taken from a cadaver donor, tested,
sterilized and prepared to fit the exact contour of the defect and press
fit into place typically through an open incision.
Fresh Allograft Cartilage: In some cases with cartilage damage, fresh treated allograft cartilage
grafts (from juvenile donors) is used in sealing the defect and help in
Labral repair: There are significant advanced today in our ability to repair the labral
tear including techniques of fixation, instrumentation, anchors, suture
materials and grafting techniques.
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