Outcomes of Joint Preservation Procedures for Cartilage Injuries in the Hip: A Systematic Review and Meta-analysis

Abstract

Background:The detection and management of chondral injuries of the hip, especially in a younger patient population, may preempt joint degeneration. Although the outcomes of preservation techniques have been well described for other weightbearing joints, such as the knee, evidence for hip joint preservation after procedures such as microfracture and autologous chondrocyte implantation remains in its infancy.Purpose:To evaluate outcomes of joint preservation procedures in the hip, including the success rate and patient-reported outcomes (PROs).Study Design:Systematic review; Level of evidence, 4.Methods:This review was performed using the terms “hip arthroscopy,” “microfracture,” “autologous chondrocyte implantation,” “fibrin glue,” “osteochondral transfer,” and variations thereof in 5 electronic databases, yielding 325 abstracts. After the application of eligibility criteria, 19 articles were included. Weighted means were calculated for PROs, and pooled estimates were calculated for age, follow-up, chondral lesion size, and success of hip preservation procedures with a random-effects proportion meta-analysis.Results:A total of 1484 patients (1502 hips) were identified across 19 studies (mean age, 38.0 ± 1.3 years; mean follow-up, 31.8 ± 9.6 months). Hip joint preservation techniques demonstrated a high success rate, ranging from 85.6% to 99.7%. The mean pooled chondral lesion size was 2.5 ± 0.3 cm2 (95% CI, 1.9-3.0 cm2). Microfracture was the most frequent technique, utilized by 11 studies, and demonstrated an 89.6% success rate (95% CI, 82.4%-96.7%). The highest pooled success rate was exhibited by autologous membrane-induced chondrogenesis in 3 studies (99.7% [95% CI, 99.0%-100.0%]). All PROs demonstrated a statistically significant increase postoperatively, including the modified Harris Hip Score, Nonarthritic Hip Score, and Hip Outcome Score–Activities of Daily Living and Hip Outcome Score–Sports-Specific Subscale (all P < .05). The visual analog scale for pain also demonstrated a statistically significant decrease of 37.2% (P < .05).Conclusion:Hip preservation procedures demonstrate a high success rate, with microfracture representing the most frequently utilized cartilage preservation technique in the peer-reviewed literature. PROs significantly improved after surgery. Further investigation of hip preservation modalities with long-term follow-up is required to create evidence-based clinical recommendations and treatment algorithms.

Femoroacetabular Impingement: What the Surgeon Wants to Know

“…However, smaller sized lesions are amenable to other interventions such as microfracture, fibrin adhesive, autologous chondrocyte implantation, and autologous membrane-induced chondrogenesis. [134][135][136] Therefore the amount of cartilage loss identified preoperatively on MRI, especially if quantified, may help determine the best approach.…”

Midterm Follow-Up and Assessment of Cartilage Thickness by Arthro-Magnetic Resonance Imaging After Arthroscopic Cam Resection, Labral Repair, and Rim Trimming Without Labral Detachment

“…The mean surface area of microfracture was 215 mm 2 . This was larger compared to other studies dealing with microfracture 36 . In spite of this, the cases with microfracture did not differ from the rest in terms of PROMs, but had significantly higher preoperative AP, AD and reduction of AD.…”

Microfracture in Hip Arthroscopy. Keep It Simple!

“…The goal with the microfracture is to promote migration of stem cells and growth factors from beneath the subchondral bone plate into the cartilage defect, which eventually heals to form fibrocartilage 1, 2, 3. Currently, many options have been put forth for the treatment of severe chondral lesions, yet microfracture remains as a popular choice mainly for its simplicity 2, 4, 5, 6, 7, 8, 9.…”