Can You Rebuild Cartilage?
Your hip cartilage is a smooth surface that cushions the ball and socket of the hip joint to keep your bones from rubbing against each other. A hip injury or trauma to the hip could wear down your cartilage and cause pain or difficulty walking.
There are innovative surgical cartilage repair and restoration procedures that may be helpful for your condition. Our orthopedic surgeons at University of Utah Health will use the best available methods to rebuild your damaged cartilage and prolong the life of your hip joint.
Types of Hip Cartilage Repair Surgery
There are several different types of procedures we use to restore the cartilage. We offer the following treatment options:
- Microfracture
- Autologous matrix-enhanced chondrocyte transplantation (AMECT) (Read research by our providers on this treatment type.)
- Autologous chondrocyte implantation (ACI)
- Osteochondral grafting
- Osteochondral autograft transplant
- Osteochondral allograft transplant
Microfracture
This is a common surgical technique used to repair damaged articular cartilage in your hip. Articular cartilage injuries can cause damage to a point where it cannot repair itself. The microfracture procedure is designed to help improve the blood flow to the injured area. This helps stimulate fibrocartilage growth into the area of injury, to fill the space of the injured cartilage.
Who Do We Recommend Microfracture For?
We recommend microfracture to patients who:
- have cartilage degeneration in a small area of the hip,
- have hip pain from multiple cartilage injuries, or
- are younger, more active patients.
We do not recommend microfracture if you:
- are inactive,
- are unwilling or unable to participate in a rehabilitation program after the procedure, or
- have widespread arthritis of the hip.
The Procedure
Before we begin the surgery, we will give you a spinal anesthetic or general anesthetic to help you fall asleep. We will then make small incisions (cuts) in your skin: one for the camera that allows us to visualize the inside of your joint, and the second to insert our surgical tools and perform the surgery.
First, we will search for and remove any damaged cartilage. Next, we will use a sharp tool/drill to poke tiny holes (microfractures) in the bone located below the cartilage. These small holes help bring blood from the deeper layers of the bone to its surface. This, in turn, creates a nourishing environment for the fibrocartilage to restore and renew itself.
Oftentimes, this surgery is done along with other procedures to treat the problem in your hip.
The Risks
As with any surgery, there are possible risks that may occur when undergoing a microfracture procedure such as:
- bleeding,
- infection,
- increased stiffness, or
- breaking down of the newly formed cartilage.
Autologous Chondrocyte Implantation (ACI)
This two-part method uses healthy cartilage from your own body to fix cartilage damage and defects. In the first stage, we use an arthroscope to find healthy cartilage from a joint in your body that does not bear any weight. We then send the cells off to a laboratory to multiply for three to five weeks until we are ready to use them for the second part of the surgery.
In the next phase, we remove the unhealthy tissue through an incision, sew a piece of bone membrane over the cartilage defect, and seal it with glue. During the final step, we inject the healthy cartilage cells underneath the membrane into the defect. This allows the cells to grow in place of the defect and form new cartilage.
An ACI is only used in select individuals.
Osteochondral Grafting
This type of cartilage repair method also uses a plug of healthy bone and cartilage to replace damaged cartilage and the underlying bone. Typically, this type of surgery has to be performed through a larger incision.
Osteochondral Autograft Transplant
This procedure is generally recommended for younger patients under the age of 50 who have only minimal cartilage damage and enough healthy cartilage available to replace the damaged cartilage.
We use a tool that works like an apple corer to remove the damaged cartilage. Once we core out the bad cartilage, we proceed to core out plugs of healthy cartilage and bone from another part of the hip that is less important. These healthy cartilage plugs are then shaped to fit perfectly in the holes where we got rid of the bad cartilage. As time progresses, the healthy cartilage will grow into the damaged area of the hip and provide better support to your hip.
The Risks
It is normal to feel pain and discomfort after your surgery, but there are risks related to undergoing an osteochondral autograft transplant like:
- bleeding after surgery,
- infection,
- stiffness,
- deep vein thrombosis (blood clot in the vein),
- numbness at the incision site, and
- injury to the vessels and nerves.
Osteochondral Allograft Transplant
This surgical technique is slightly different from an osteochondral autograft transplant because it removes healthy cartilage from a cadaver (tissue donor) instead of your own body. We typically use osteochondral allograft transplants on people with large cartilage defects or who have failed to see improvement using other surgeries. Osteoarthritis patients are not good candidates for this procedure.
During this procedure, the hyaline cartilage, the most common type of cartilage that has a glassy appearance, is collected from a cadaver (tissue donor). This tissue is sterilized and screened for possible diseases before becoming available to you.
We size the healthy cartilage graft to match your anatomy because we want to restore your joint’s natural geometry as much as possible. Then we transplant the allograft into the damaged area.
We sometimes use screws and pins to hold the graft to the damaged area. For larger grafts, your joint needs to be sized to a similar donor. Once we locate a donor, there is a short window of a couple of weeks where we need to do the surgery because the graft contains live cells.
The Limitations
While rare, there are a few potential disadvantages to opting for this type of hip restoration surgery, which include:
- a waiting period due to a limited number of donor grafts,
- lack of incorporation, and
- a possibility of disease transmission, although this possibility is similar to a blood transfusion. Grafts we use at the university come from certified tissue banks and are highly tested before we use them.
Find a Hip Preservation Specialist
Hip Cartilage Repair Recovery Time
During the First Month
For a safe and smooth recovery, make sure you follow the instructions given by your doctor.
- Use your crutches to keep all the weight off of your hip to ensure quicker healing and to protect the surgical area. You may need to use these for up to six weeks depending on how your body is recovering.
- Only take your prescription pain medicine as needed.
- Use a continuous passive machine (CPM) for four to six hours a day during the first two weeks. This machine assists with hip motion in the early surgical recovery period. You should not use this machine routinely.
- Prevent blood clots by flexing both of your ankles up and down during the first few weeks after your surgery. Although you will protect your surgical site by walking with crutches, we encourage you to get moving when it is safe and comfortable. This will minimize the risk of blood clots.
- Schedule a follow-up appointment with your doctor one to four weeks after surgery, depending on what your surgeon prefers.
While your overall recovery and return to more aggressive sports may take six to 12 months, you will be allowed to do simple exercises relatively early. These simple exercises will help you maintain mobility and prevent your muscles from atrophying (becoming weak).
You can do lighter sports that don’t require aggressive twisting, pivoting, jumping, or contact with others around three to six months after your surgery, depending upon how quickly you are recovering.
