Cartilage is the tough, flexible tissue that covers the surface of the joints, including the hip. It cushions the joints, acting as a shock absorber, and helps the bones to slide smoothly over one another for ease of movement. Injuries to the cartilage are common and can be the result of gradual wear and tear, as in the case of osteoarthritis, or sudden trauma, such as with a sporting injury.
Hip cartilage injuries sometimes get better by themselves, however more severe damage may require surgery. Because cartilage has no blood supply of its own, cartilage injuries can take much longer to heal than other types of tissue injury.
There are several possible causes of cartilage injury in the hip:
- Gradual wear and tear can cause damage to the cartilage, particularly in people who are obese or who have osteoarthritis
- Trauma caused by a heavy blow, such as a car accident or bad fall, or a collision during certain types of sport can result in cartilage damage
- Immobility increases the risk of damage to hip cartilage.
Symptoms associated with damaged hip cartilage include:
- Pain in the hip which is constant, even when resting, and gets worse when you stand or walk
- Stiffness and swelling
- A grinding sensation or a feeling of the joint catching, locking or giving way
Your consultant will recommend a range of tests to diagnose the cause of your symptoms. These might include:
If the injury is relatively minor you may be able to treat it at home. You should rest the hip, apply a cold compress to the area and keep it elevated. Painkillers and anti-inflammatories can be taken to relieve pain and reduce swelling.
Physiotherapy may help to relieve stiffness, improve flexibility and increase movement. By strengthening the muscles surrounding your joint it can help to relieve pressure and reduce pain.
For more severe injuries, or if self-help treatment does not relieve the problem, you may require surgery. Among the surgical treatments offered for cartilage injuries are:
- Hip arthroscopy – this is a minimally invasive form of surgery – also called keyhole surgery – which involves making a small incision in the skin and inserting a thin flexible instrument called an arthroscope, which has a camera at one end. This enables the consultant to see inside your joint and tiny surgical instruments can be inserted to carry out some of the surgical procedures described below.
- Lavage and debridement – this involves removing any loose cartilage and trimming the edges of the damaged area to make them smooth. If possible, damaged areas of cartilage will be repaired.
- Microfracture – this is a procedure that involves drilling small holes in the bone to release bone marrow into it. The bone marrow encourages new cartilage to grow.
- Mosaicplasty – this involves replacing damaged cartilage with small plugs of healthy cartilage taken from another part of the joint.
- Autologous chondrocyte implantation – this entails removing a small piece of cartilage and growing more cartilage cells in a laboratory. After a month, these cells are implanted into the damaged joint where they will grow into healthy tissue.
- Hip replacement may be necessary for the most severe types of cartilage injury. This entails replacing the joint with a prosthetic implant.
- Regenerative treatments