NANOFRACTURE

The ends of the femur and acetabulum – the hip bones – are capped with a smooth surface called articular cartilage.  Cartilage protects the ends of bone; it can withstand a tremendous amount of force and is significantly smoother than ice, which allows smooth motion in the hip joint. An articular cartilage injury (chondral injury), may occur following a twisting injury to the hip, a direct blow, or wear and tear as a one ages. The cartilage has a very limited bloody supply, and full-thickness cartilage lesions cannot heal without surgical intervention. In those patients with full-thickness cartilage damage and recurrent symptoms, surgical intervention may be the best option.

During surgery, Dr. Welch introduces a camera through one small incision and surgical instruments through two other small incisions.   Dr. Welch uses surgical instruments to remove the loose pieces of cartilage and areas of fraying. Dr. Welch then identifies the full-thickness cartilage damage (in which bone is exposed). If the cartilage damage is relatively small, Dr. Welch uses a small, sharp device to make tiny holes in the bone beneath the damaged cartilage. This technique (nanofracture) stimulates bone marrow cells to migrate to the damaged area and produce new cartilage. Usually, the cells produce a layer of cartilage called fibrocartilage that helps protect the exposed bone. Another emerging option for cartilage surgery is the use of healthy, donor cartilage cells to treat the area of full thickness cartilage damage.

Postoperative Rehabilitation

Following surgery, Dr. Welch recommends a guided physical therapy program with a licensed physical therapist. Early motion following surgery is very important for cartilage surgery, and Dr. Welch recommends that each patient either use a stationary bike or a continuous passive motion machine daily. Dr. Welch also recommends limited weight bearing and crutch use for 4-6 weeks after surgery. Dr. Welch may also recommend the use of a brace for approximately two weeks to help protect the hip.

Following surgery, Dr. Welch prescribes appropriate pain medication as well as an anti-inflammatory medication. Anti-inflammatory medication (such as Naprosyn) is important because it can help eliminate pain and also may prevent the formation of abnormal bone (heterotopic ossification).