Chondral lesions on the articular surface of the acetabulum are a serious finding at hip arthroscopy. The literature has shown that if these lesions are left untreated they may lead to the development of osteoarthritis and degeneration of the hip joint. These defects have been shown to have no healing potential without surgical intervention, and the technique of choice is microfracture. This involves stimulation of the subchondral bone so that new fibrocartilage is produced, which will heal these areas.
The modern literature lacks studies correlating the results of hip arthroscopy with the size of chondral defects. A recent publication studied the relationship between their size and the outcome of hip arthroscopy. It was conducted between February 2008 and November 2014. Data were collected on patients who underwent hip arthroscopy. Microfracture of the articular surface of the acetabulum was performed in all of them, while the accompanying conditions were labral tears and femoroacetabular impingement syndrome. Patients were assessed with the hip outcome scales Harris Hip Score, Non Arthritic Hip Score, Hip Outcome Score Sports Specific Subscale and a visual analogue scale for pain.
131 patient cases were included, of which 107 had a minimum follow-up of two years. Patients were categorised into groups according to the surface area of the chondral lesion, with small chondral lesions defined as ≤ 150mm2 and larger ones as ≥ 200mm2.
35 patients were included in each group and the mean follow-up was 47.9 months for the large chondral lesions and 46.1 months for the small ones.
Both groups showed significant improvements in all the scores. The rate of conversion of the procedure to total hip arthroplasty was similar in both groups. However, the relative risk of total hip arthroplasty was greater in patients with lesions ≥ 300mm2.
The authors concluded that patients with smaller or larger chondral lesions, when these do not exceed 300mm2 and when they are accompanied by surgical treatment of the labral tear and of femoroacetabular impingement syndrome, show similar improvement at two years of follow-up. However, patients with chondral lesions exceeding 300mm2 may be more predisposed to total hip arthroplasty.
Source: “Arthroscopy”, July 2019
