Hip cartilage injury
HIP CARTILAGE DAMAGE
(hip/acetabular cartilage tear, hip/acetabular cartilage injury)
Hip articular cartilage covers the ball of femoral head and socket of the acetabulum allowing them
to move against each other without causing damage in the hip.
Articular cartilage does not contain blood vessels and is produced by chondrocytes, which are
cells that divide very slowly. This are the reasons that articular cartilage injuries do not repair and
can lead to continued deterioration of joint. Arthroscopic grading system ranks the extent of
cartilage defects from grade 1 (soft spot or blisters) to grade 4 (cartilage tear exposes the bone).
Cartilage tearing can be caused by traumatic injuries, infections, congenital abnormalities of hip
joint (hip dysplasia or femoroacetabular impingement), sustained stress or lack of movement over
a prolonged period of time. It is common injury in impact sports, activities with repetitive use of the
hip joints or those that require sudden changes of movements direction and twisting (running,
jumping, ice hokey, football, ballet, snow skiing, netball etc.) Elderly people and obese individuals
are at higher risk.
The injury of cartilage can be focal or generalized over the entire joint, if not treated properly, and
can lead to osteoarthritis (complete cartilage worn off). The torn fragment of cartilage can also
protrude into the joint (loose body). If there is a presence of minor focal tear in the cartilage,
symptom can be absent. In serious cases of cartilage damage patients complain of pain and
stiffness especially during exercise in the entire hip, groin area and/or buttock with presence of
swelling and restriction in hip range movements. Pain is getting progressively worse over the years.
Physical therapy is performed postoperatively or in those patients who are suffering of moderate
symptoms and surgery is not yet needed, and can be started once the symptoms subside. It
involves hip strengthening and stretching exercises that stabilize the joint, balance the muscles
around the hip joint and improve range of motion. The goal is also to make changes in the hip
movements during activities so that the hips are not under to much pressure and to reduce the
burden on the already damaged cartilage and protect healthy portion of cartilage from further
deterioration. Rehabilitation usually takes 8 to 12 weeks.
Prevention: maintaining strength and flexibility of the muscles surrounding and supporting hip area,
properly warm - up before activity and stretching after, training technique correction, wearing
proper footwear (well cushioned shoes, gel-type shoe inserts, avoid wearing high heels), adequate
recovery periods from sport or activity, training on appropriate surfaces (avoiding standing or
walking on hard surfaces for a prolonged period of time), adequate rehabilitation following a
previous hip injury, good core stability, paying attention to body weight, wearing a cane or stick on
the opposite side to reduce stress on affected hip, pool exercise.