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.
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. 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.
Surgical hip dislocation is performed to treat chondral injuries when non-surgical options are ineffective, and pain persists.
Surgical hip dislocation is performed under general anesthesia. Your surgeon makes an incision along the side of your hip. The upper part (greater trochanter) of your thigh bone (femur) is cut to allow access to the joint without incising much muscle tissue. Arteries and nerves are carefully identified and protected. The bones are then disjointed, and the articular surfaces treated. After re-articulating the bones, the cut part of the femur is replaced and fixed with screws. The incision is covered with a gauze dressing. The entire procedure takes about 2-3 hours. Ice is applied to control pain and swelling for which your doctor also prescribes medication. You are placed on crutches for about 6 weeks.
Surgical hip dislocation carries a significant risk of damage to the blood supply of the head of the femur. Other risks may include blood loss, infection and nerve damage, which may occur with any surgery.
A chondral injury is damage to the articular cartilage covering the bones of the joints resulting in pain, swelling and impaired function. Unlike other tissues, cartilage does not have its own blood supply, and therefore requires longer time to heal. The management of chondral injuries depends on the severity of the injury and includes non- surgical and surgical modalities of treatment.