San Diego Spine Center

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.

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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 joint preservation.

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.