Hip Cartilage Injuries

A cartilage defect refers to a specific, localized area of damage to the articular cartilage that lines the ends of the bones (like a tile missing in the floor).

Focal cartilage damage is typically caused by an acute traumatic injury, degenerative conditions, developmental issues, or a combination of these factors. When the underlying bone beneath the cartilage is also damaged it is called an osteochondral injury.

Trauma or Injury:

Direct trauma or impact to the hip joint, such as a fall or a sports-related injury, can cause damage to the cartilage.

Hip Dislocation or Subluxation:

Dislocation or partial dislocation of the hip joint can lead to cartilage damage. Developmental Dysplasia of the Hip: Development dysplasia of the hip joint, which may occur during fetal development or infancy, can lead to instability and abnormal loading on the hip cartilage, causing defects over time. When the socket is too shallow, the load of the hip gets distributed in a smaller area. Therefore, with time the increased pressure and potential microinstability of the hip can cause damage in the “roof” of the hip as a result.

Osteoarthritis:

Osteoarthritis, a degenerative joint disease, can lead to the breakdown of cartilage in the hip joint over time. This can result from wear and tear, aging, or genetic factors. Unfortunately, minimally invasive hip arthroscopy is not a good option for patients with significant generalized cartilage damage, as outcomes are suboptimal.

Femoroacetabular Impingement (FAI):

FAI is a condition where there is abnormal contact between the femoral head and the acetabulum. This can lead to increased stress on the cartilage and may contribute to the development of focal defects.

Inflammatory Joint Diseases:

Rheumatoid Arthritis or other autoimmune conditions can cause inflammation and damage to the cartilage in the hip joint.

Genetic Factors:

Some individuals may be genetically predisposed to conditions that affect cartilage health, leading to the development of focal defects.

Focal cartilage defects in the hip are often categorized based on various factors, including their size, depth, and location within the joint. Focal cartilage defects are graded by severity. Grade I is the mildest and grade IV is the most severe describing full thickness injury of the cartilage.

Cartilage does not have nerves and therefore does not cause pain when damaged. However, irritation of the bone beneath the cartilage or the lining of the joint (synovium) that results from cartilage loss can cause pain.  Common symptoms of a cartilage defect include:

• Joint Pain: A focal cartilage defect typically causes pain in the hip joint. The pain is typically a dull ache, with intermittent sharp pain, felt deep within the groin. The pain often worsens with activity and improves with rest.
• Stiffness: People with a focal cartilage defect may experience stiffness in the hip joint, making it difficult to move the hip through its full range of motion.
• Reduced Range of Motion: As the condition progresses, the range of motion in the hip joint may become limited, making it challenging to perform activities like walking, getting into/out of a car, dressing, or climbing stairs.
• Crepitus: Some people with a cartilage defect may notice a grinding or grating sensation in the hip joint, which is known as crepitus.
• Catching/locking: Catching or locking of the hip joint can occur in cases where a loose body of cartilage is present within the hip joint.

Physical Exam

A comprehensive physical exam will be conducted to assess the range of motion in your hip joint, look for signs of inflammation or swelling, and feel for areas of tenderness or crepitus (grating or grinding sensations). Your gait (the way you walk) will also be evaluated to identify any abnormalities.

Imaging

Diagnostic imaging is necessary to definitively diagnose a focal cartilage defect of the hip.  X-rays will allow Dr. Chahla to assess the degree of remaining joint space, the extent of cartilage damage, and possible subchondral involvement. Dr. Chahla will also recommend an MRI of the hip to further assess the size and extent of the focal cartilage defect, subchondral involvement, and any possible concomitant injuries such as to the hip labrum.

Hip Injection

An intra-articular hip injection can help to confirm the diagnosis of a symptomatic focal cartilage defect of the hip. This injection will be performed in the office at the time of your office visit under ultrasound guidance. If the majority of your pain goes away, even temporarily, following the injection, then it confirms that the source of the pain is due to intra-articular hip pathology.