Hip arthroscopy has evolved considerably over the past 15 years. The surgical techniques and instruments have been refined to a point where skilled surgeons can accomplish a lot inside the hip in a relatively short period of time. Since the procedure is technically challenging, however, (requires a special 70 degree arthroscope, works in a deep part of the body in a narrow space, and requires joint distraction – which puts a time limit on the length of surgery) it is not ready for ‘mainstream’ practice – as most surgeons don’t have the opportunity to get specialized or advanced training in arthroscopy. This reality, as well as the difficulty of reaching cartilage lesions deep on the femoral head or deep in the acetabular socket, has made treating cartilage lesions difficult.
We have decent strategies for cartilage repair/restoration in the knee, and less so in the ankle and shoulder, but in the hip the options are very limited. Converting to an ‘open’ surgery to transplant cartilage in the hip is much more impactful and difficult for the surgeon and the patient as compared to the knee, for example.
Attached are a couple of pictures showing cartilage defects. These could be repaired by microfracture technique or a cartilage transplantation procedure like Autologous Chondrocyte Implantation (ACI) or DeNovo NT. These latter two techniques are currently performed with open surgery, but Dr. Hyman is developing a technique to do the cartilage repair arthroscopically.
For more information on this, and other surgical techniques, see my website at www.hiparthroscopydoctor.com
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