American Hip Institute

2015- Domb et al. Microfracture in the hip: a matched-control study with average 3-year follow-up

Parth Lodhia1, Chengcheng Gui1, Sivashankar Chandrasekaran1, Carlos Suarez-Ahedo1, S. Pavan Vemula1 and Benjamin G. Domb1,2,*

There is a paucity of literature regarding microfracture surgery in the hip. The purpose of this study was to compare outcomes in patients undergoing hip arthroscopy predominantly for labral tears with focal full thickness chondral damage on the acetabulum or femoral head treated with microfracture and a matched control group that did not have focal full thickness chondral damage. A prospective matched-control study was performed examining four patient-reported outcome (PRO) scores: modified Harris Hip Score (mHHS), non-arthritic hip score, Hip Outcome Score-Activities of Daily Living (HOS-ADL), and Hip Outcome Score-Sports Specific Subscale (HOS-SSS) at minimum 2 years post-operatively between 35 patients undergoing microfracture for chondral defects during hip arthroscopy and 70 patients in a control group that did not have chondral defects

The patients were matched based on gender, age within 7 years, Workman's compensation claim, labral treatment and acetabular crossover percentage less than or greater than 20. There was no significant difference (P>0.05) in PRO scores preoperatively between the groups. Both groups demonstrated significant improvement (P<0.05) in all post-operative PRO scores at all time points. There was no statistically significant difference (P>0.05) in post-operative PRO scores between the microfracture and control groups, except for HOS-ADL and the visual analog scale (VAS) score, both of which were superior in the control group (P<0.05). Patient satisfaction was 6.9 for the microfracture group and 7.7 for the control group (P>0.05). Arthroscopic microfracture of the hip during treatment of labral tears results in favorable outcomes that are similar to the results arthroscopic treatment of labral tears in patients without full thickness chondral damage.

INTRODUCTION: Management of articular cartilage injuries is a challenge [1]. Defects in the articular cartilage have a limited capacity to heal regardless of the nature of injury [2]. Untreated lesions may lead to progression of arthritis and add to patient morbidity [3]. Chondral injuries in the hip can occur in a variety of hip disorders, can be atraumatic or traumatic, and can serve as an obscure source of pain.

The goal of microfracture is to bring marrow cells and growth factors from the underlying bone marrow into the affected chondral defect. By penetrating the subchondral bone, pluripotent marrow cells can develop and form new fibrocartilage to fill the chondral defect. As the popularity of hip arthroscopy has increased in recent years, there has been a focus on prevention of chondral damage and managing pre-existing chondral injuries by extrapolating the technique and results of microfracture that has been validated in the knee [4].

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