Hip Microfracture

What is Hip Microfracture?

Hip Microfracture is a marrow-stimulating technique that creates a network of small holes in the bone below the hip cartilage (subchondral bone). The goal of the procedure is to increase the blood supply to stimulate cartilage growth. 

The hip joint is a ball and socket joint surrounded by muscles, ligaments, and tendons. The thigh bone or femur and the pelvis join to form the hip joint. The articular surfaces of the hip joint are lined by hyaline cartilage, a smooth tissue that serves as a shock absorber and allows easy movement of the bones within the joint. 

Indications

Hip microfracture is indicated for hip chondral lesions (damage to hip cartilage). Normal wear-and-tear or injury can damage and cause defects in the hip cartilage, resulting in irregular articular surfaces that interfere with movement, causing pain, swelling and disability. Hip chondral lesions may also be caused due to developmental abnormalities or diseases like Legg Calves Perthes. You may experience pain in the groin area, catching sensation, stiffness around the hip and loss of motion.

Am I a Good Candidate for Hip Microfracture?

Hip microfracture is recommended by your doctor if you:

• are physically active
• have limited cartilage damage
• do not have hip arthritis or instability
• are willing to participate in the rehabilitation program

Preparing for the Surgery

Your doctor will assess your symptoms and take a medical history. Your doctor will perform a complete physical examination to make sure you have no conditions which could negatively affect the surgical outcome. Imaging tests such as X-ray, MRI or CT-scan will be ordered. Certain blood tests may be ordered. Talk to your doctor about the medicines you are taking prior to the procedure. Inform your doctor if you are allergic to any medicines or anaesthesia. Arrange for someone to drive you home after the procedure.

Hip Microfracture Procedure

The surgery is performed arthroscopically. Arthroscopy, also referred to as keyhole or minimally invasive surgery, is a procedure that uses an arthroscope to perform a surgery. 
An arthroscope is a small, fibre-optic instrument consisting of a lens, light source, and video camera. The camera projects images of the inside of the joint onto a large monitor, allowing your surgeon to look for any damage, assess the type of injury and repair the problem.

The hip microfracture surgery involves the following procedure:

• You are given general or local anaesthesia.
• A foot stirrup is used to add force for the distraction of the operative leg. An anterior or mid-anterior portal is established.
• A diagnostic arthroscopy is performed to look at the size and extent of the lesion.
• An arthroscopic curette is used to remove calcified cartilage.
• Your surgeon performs arthroscopic picking (inserts a small pick-like structure) to create holes that are separated from each other at a distance 3mm to 4mm.
• A shaver is used to clear the debris accumulated on the holes to obtain clear open holes.
• Marrow flows out of the holes which helps in the formation of new cartilage.

Recovery after the Procedure

Pain medications are used to manage pain. Your physiotherapist teaches you how to use a walker or crutches and may begin with light weight-bearing exercises. Specific physical exercises will be given to help you recover fast. You should regularly follow-up with your surgeon. You may return to sports after a few months with your surgeon’s approval.