Osteochonral reconstruction of articular surface

Your hip joints play a significant role in your ability to move and function effectively. As a result, problems affecting one or both of the hip joints can have a big impact upon life.

Where both the cartilage and the bone underneath the cartilage is damaged, you may be advised to undergo a particular type of surgery known as ‘osteochondral reconstruction of the articular surface’.

What is an osteochondral injury?

The hip joint is termed a ‘ball-and-socket’ joint, a reference to the top of the femur (the ‘ball’, also known as the femoral head) articulating with the acetabulum of the pelvis (the ‘socket’) to allow movement of the joint.

While the structure of the hip joint provides good strength and stability, diseases such as osteoarthritis are fairly common in the hip and can be debilitating for people affected by them.

The bones in your joints are lined at their ends with cartilage, known as ‘articular cartilage’. In the hip joint, this cartilage lining helps the ‘ball and socket’ to move freely around each other.

Damage to the cartilage can lead to pain in the hip joint, as the femur and acetabulum grate against each other due to the uneven surfaces.

An osteochondral injury is the medical term used to describe damage to both the articular cartilage and the bone underneath it. This damage to the bone underneath the cartilage can range from tiny cracks to larger breaks.

The femoral head and/or the acetabulum may also be damaged, leading to a condition known as ‘femoro-acetabular impingement’.

Should you have experienced damage to the articular surface of either the head of your femur or your acetabulum, you will usually find your ability to move your hip joint without pain or stiffness has significantly altered.

While you may be able to tolerate a certain level of discomfort, worsening pain and mobility is not something you would want long-term.

Advances in surgical technology and medical knowledge means that many joint problems can now be suitably treated using arthroscopy, a type of keyhole surgery.

A hip arthroscopy is normally carried out under general anaesthetic, meaning you will not be conscious during the surgery. An anaesthetist will talk with you about the anaesthetic they will be using for the procedure, and if you have any queries at any time, they will be happy to help.

Once you have been given the general anaesthetic, the skin around the hip will be thoroughly cleaned using an antibacterial fluid, to reduce the risk of infection. A cut of only a few millimetres in size will then be made in the skin near the hip joint and a small metal tube (called an arthroscope) inserted into the hip joint through this cut. The arthroscope contains a light source and a small camera, giving the surgeon a clear view of the inside of the hip joint.

Using the arthroscope, the surgeon is able to examine the damaged areas of articular cartilage and bone. They will make additional small incisions if needed in order to insert small surgical tools into the joint in order to repair the damage. Reconstruction is normally achieved by grafting a small section of bone with articular cartilage into the damage area. The grafted bone is referred to as an ‘osteochondral plug’.

Once the damaged area has been successfully reconstructed, the surgeon will remove the arthroscope from the joint and close the cuts using stitches or special surgical tape, covering the area with a sterile dressing to ensure it remains free of infection.  

This type of joint preservation procedure was previously only carried out on the knee. Advances in hip arthroscopy techniques now enable it to be used in the hip joint as well. Using arthroscopy means that it is a much less invasive surgical procedure than traditional (“open”) surgery.

Advantages of this type of keyhole surgery include:

  • reduced recovery time,
  • lower risk of infection,
  • less pain following the surgery,
  • less time spent in hospital.

Although this procedure is carried out using keyhole surgery, it does mean that it is risk-free; all surgery has risks and the potential for complications. In particular, you should be aware of the possibility of:

  • Infection in the hip joint,
  • Bleeding inside the hip joint,
  • Damage to the nerves near the hip joint,
  • Formation of a blood clot (known as a ‘deep vein thrombosis’ or ‘DVT’).

The above risks are intended as guidelines only and are not exhaustive. We always recommend that you talk with your consultant about potential risks and complications before you decide to have any surgery.

Expert diagnosis and treatment of your hip problem

The consultant-led orthopaedic Hip Clinic at St Joseph’s has vast experience in carrying out arthroscopic procedures in the hip. Should you require help for pain, discomfort or stiffness in your hip, please contact us to arrange a consultation with one of our hip specialists. They will work with you to help diagnose and effectively treat the cause of your hip problem.

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