Therapy

The appropriate therapy for the cartilage damage in the hip joint depends crucially on the given circumstances. For example, cartilage tissue in children can regenerate itself relatively well as long as the damage does not exceed a certain extent. The cartilage of adults hardly regenerates itself, which is why in these cases surgery is usually decided upon.

If the damage is very minor, it may be possible to wait for a surgical intervention and start with a non-surgical therapy. This includes physiotherapeutic and physical treatment, as well as pain-relieving drug therapy. Since cartilage damage in the hip joint is proportionally often correlated with a high load on the joint, it is a priority to stop this load, if possible.

This applies to certain movements as well as loads that are due to overweight. If overweight is present, it should be reduced to normal weight as soon as possible. Every step would otherwise put unnecessary strain on the cartilage.

Therefore, under certain circumstances, nutritional and sports advice should be given. Insoles for sports and everyday shoes can also slightly reduce the strain on the joint. Long periods of standing, heavy lifting and walking on uneven ground should also be avoided.

Taking pain and anti-inflammatory drugs (NSAIDs) can also help. If the cartilage damage is minor and the external circumstances of the person affected (age, concomitant diseases, etc.) allow it, such a therapy can be quite promising.

Nevertheless, in most cases of severe cartilage damage, surgery on the hip joint is unavoidable. The operation is usually minimally invasive, using hip joint arthroscopy. There are several methods to repair the damaged tissue in the hip joint.

These include the so-called microfracturing, which causes bleeding and stimulates the tissue to form cartilage. There is also the procedure of cartilage transplantation, in which cartilage is taken from other joints and inserted into the affected joint, or the procedure of stem cell transplantation, in which stem cells are stimulated to form cartilage tissue and the material is then inserted into the affected joint. The treatment of cartilage damage to the hip depends on the severity of the hip joint arthrosis (classification according to ICRS: International Cartilage Society).

If hip joint arthrosis grade 1 exists, a minimally invasive hip joint endoscopy (arthroscopy of the hip) is performed, in which overgrowing bone and free joint bodies are removed and torn cartilage parts and the partially impaired joint capsule are removed.
In advanced stage 2 arthrosis in younger patients under 60/65 years of age, a joint-preserving intervention via arthroscopy makes little sense. Hip joint prostheses are used here, which are inserted under general or partial anesthesia via a skin incision above the lateral hip joint (anterolateral access). In order to preserve as much of the healthy hip joint or femur as possible, in this case either only a femoral head cap without femoral neck resection or an implantation of a short stem prosthesis is usually performed.
In contrast, in advanced hip joint arthrosis stage 3 in older patients over 60/65 years of age, a complete hip joint replacement is usually aimed for, whereby both the femoral head and the acetabulum are replaced.

Cartilage cultivation is the so-called cartilage cell transplantation (synonymously also autologous chondrocyte transplantation (ACT)), in which the introduction of cartilage cells into the affected joint (e.g. hip joint) can lead to the reconstruction of joint cartilage.

This procedure is usually performed in younger hip joint patients with deep but locally limited cartilage damage surrounded by still intact cartilage tissue. As a rule, autologous cartilage cells are used for cartilage transplantation, but in certain cases donor cells may also be used. In endogenous cartilage cultivation, healthy cartilage cells are taken from an intact cartilage area by means of a biopsy during arthroscopy, which can then be cultivated in the laboratory under certain conditions.

In a further step, these cartilage cells are cultivated or multiplied over 3-4 weeks in serum of the patient’s own blood, which was also taken during arthroscopy. In the last step, the cultured cells are reimplanted into the patient’s hip joint in another, minimally invasive procedure after the defective cartilage tissue has been removed. The introduced cartilage cells now grow into the defect and proliferate, so that a complete regeneration of the cartilage is expected after approximately 1 year.