Chondral Lesions or Injuries
The hip joint is one of the largest weight-bearing joints in the body, formed by the thigh bone or femur and the acetabulum of the pelvis. It is a ball and socket joint with the head of the femur as the ball and the pelvic acetabulum forming the socket. The joint surface is covered by a smooth articular cartilage which acts as a cushion and enables smooth movements of the joint. A chondral injury refers to an injury of the articular cartilage, covering the joint.
Chondral injuries can result from various hip conditions such as labral tears, loose bodies, posterior dislocation, slipped capital femoral epiphysis (SCFE), dysplasia, osteonecrosis, and degenerative arthritis.
Articular cartilage covering the hip joint can also be damaged by a direct blow to the outer part of the thigh. Femoroacetabular impingement or FAI can also cause chondral injuries. This is a condition characterized by excessive friction in the hip joint causing pain and decreased range of motion. The femoral head and acetabulum rub against each other eventually causing damage to the cartilage.
A majority of patients with chondral injuries experience severe pain in the hip or groin, a locking sensation in the hip joint, and significant restriction in hip movement. In some patients, physical examination may also reveal a noticeable limp.
Diagnosis of chondral injuries involves a thorough medical history and physical examination by your doctor. In addition to this, X-rays and MRI scans are also useful in diagnosing these types of injuries. However, arthroscopy is the most accurate way of diagnosing, evaluating, and managing chondral injuries.
The management of chondral injuries depends on the severity of the injury and includes non- surgical and surgical modalities of treatment. Non-surgical treatment includes a healthy diet, regular exercise and avoidance of aggravating activities.
Arthroscopic surgery is performed to treat chondral injuries when non-surgical options are ineffective and pain persists.
Hip arthroscopy, also referred to as keyhole surgery or minimally invasive surgery, is a surgical procedure employing an arthroscope, a narrow tube with a tiny camera attached on the end, to assess the damage to the hip. Your surgeon makes 2 to 3 small incisions around the hip joint. The arthroscope is inserted through one of the incisions and the camera attached to the arthroscope helps visualize the joint, on a monitor. A sterile solution is pumped into the joint to clear the view and increase the space for surgery. Specially designed instruments are inserted through the other incisions. During the surgery, any loose fragments, small pieces of bone and cartilage floating within the joint are removed. After the completion of the procedure, the arthroscope is removed and incisions are closed.
Other arthroscopic surgeries that may be recommended to manage chondral injuries include:
- Micro fracture surgery: This technique to treat chondral injuries involves stimulating the formation of new articular cartilage by drilling numerous tiny holes in the bone underneath the damaged cartilage. This results in the formation of blood clots within the damaged cartilage, which stimulates the growth of new cartilage known as fibrocartilage. Although, the fibrocartilage formed is different from the normal hyaline cartilage, it can provide significant improvement in the symptoms
- Autologous Cartilage Implantation (ACI): In this procedure the cartilage, harvested from the patient or a cadaver, is cultured and later implanted over the damaged area of the joint
- Matrix-induced Autologous Chondrocyte Implantation (MACI): This technique employs cultured chondrocytes (the cells which produce the cartilage) to repair the articular cartilage damage. These chondrocytes are inserted onto a layer of collagen which is then implanted over the damaged area of the joint.
Following the surgery, your doctor will instruct you on the care of your incisions, activities to be avoided and exercise programs to hasten recovery. Physical therapy will be recommended to restore strength and mobility to the hip joint. You may also be prescribed medications to relieve pain.
Risks and Complications
Possible risks and complications specific to arthroscopic hip surgery include:
- Deep vein thrombosis (DVT)
- Blood vessel or nerve damage
- Hemarthrosis (bleeding inside the joint)
- Failure to relieve pain