The hip joint is a large, weight-bearing ball and socket joint formed by the femur (thigh bone) and the acetabulum of the pelvis. The joint surface is covered by smooth articular cartilage, which acts as a cushion and allows for smooth movement. A chondral injury is an injury to this articular cartilage.

Causes of Chondral Injuries

Chondral injuries can result from various hip conditions, including:

• Labral tears
• Loose bodies
• Posterior dislocation
• Slipped capital femoral epiphysis (SCFE)
• Dysplasia
• Osteonecrosis
• Degenerative arthritis

Damage to the articular cartilage can also be caused by a direct blow to the outer thigh. Femoral acetabular impingement (FAI), a condition with excessive friction in the hip joint, can also cause chondral injuries by causing the femoral head and acetabulum to rub against each other and damage the cartilage.

Symptoms

Most 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. A noticeable limp may also be present.

Diagnosis

Diagnosis of these injuries includes:

• A thorough medical history and physical examination by a doctor
• X-rays and MRI scans
• Arthroscopy, which is the most accurate way to diagnose, evaluate, and manage chondral injuries

Treatment

Treatment for chondral injuries depends on their severity and can be non-surgical or surgical.

• Non-surgical treatment: This includes a healthy diet, regular exercise, and avoiding activities that aggravate the injury.
• Surgical treatment: Arthroscopic surgery is performed if non-surgical options are ineffective. Microfracture surgery: This technique involves drilling tiny holes in the bone beneath the damaged cartilage to stimulate the growth of new fibrocartilage. While different from normal cartilage, it can significantly improve symptoms. Autologous cartilage implantation (ACI): Cartilage is harvested from the patient or a donor, cultured, and then implanted over the damaged area. Matrix-induced autologous chondrocyte implantation (MACI): Cultured chondrocytes (cartilage-producing cells) are inserted onto a collagen layer, which is then implanted over the damaged area.

Post-Operative Care & Risks

After surgery, a doctor will provide instructions on incision care, activities to avoid, and exercise programs. Physical therapy is recommended to restore strength and mobility, and medications may be prescribed for pain relief.

Possible risks and complications of arthroscopic hip surgery include:

• Infection
• Deep vein thrombosis (DVT)
• Blood vessel or nerve damage
• Hemoarthrosis (bleeding inside the joint)
• Failure to relieve pain