Osteochondroplasty

What is Osteochondroplasty?

Osteochondroplasty is a surgical procedure to repair and reshape damaged cartilage and protruding bony surfaces of the femur or acetabulum of the hip joint. The procedure is performed arthroscopically as a minimally invasive procedure. An arthroscope is a small, fiber-optic instrument consisting of a lens, light source, and video camera. The camera projects images of the inside of the joint onto a monitor, allowing your surgeon to look for damage, assess the severity of the injury, and perform needed repairs.

Indication for Osteochondroplasty

Osteochondroplasty is indicated for femoroacetabular impingement (FAI), abnormal growth of the femur (ball) or the acetabulum (socket) of your hip joint with cartilage/labrum damage, causing the bones to rub against each other. The common symptoms of femoroacetabular impingement include pain and stiffness in the groin, hip, and thigh region, lower-back pain, and an inability to bend the hip.

Anatomy of the Hip

The ball-and-socket joint of the hip is formed by the round end of the femur (thighbone) and the cup-shaped socket of the acetabulum (part of the pelvis). The joint surface is covered by smooth articular cartilage that cushions and enables smooth movement of the joint. Stability of the hip joint is achieved by the labrum (strong fibrous cartilage that covers the acetabulum and seals it), ligaments (tissues connecting bone to bone), and tendons (tissues connecting muscle to bone) that encase the hip and support the hip movements.

Preparation for Osteochondroplasty

Preoperative preparation for osteochondroplasty will involve the following steps:

• A thorough examination by your doctor is performed to check for any medical issues that need to be addressed prior to surgery.
• Depending on your medical history, social history, and age, you may need to undergo tests such as blood work and imaging to help detect any abnormalities that could threaten the safety of the procedure.
• You will be asked if you have allergies to medications, anesthesia, or latex.
• You should inform your doctor of any medications, vitamins, or supplements that you are taking.
• You should refrain from medications or supplements such as blood thinners, aspirin, or anti-inflammatory medicines for 1 to 2 weeks prior to surgery.
• You should not consume any solids or liquids at least 8 hours prior to surgery.
• Arrange for someone to drive you home after surgery.
• A written consent will be obtained from you after the surgical procedure has been explained in detail.

Procedure for Osteochondroplasty

The osteochondroplasty surgery is performed under general or regional anesthesia and involves the following steps:

• You will be lying on your back (supine position) on the operating table.
• Internal rotation of the limb is performed by your surgeon, which enables the placement of the arthroscope into the hip joint.
• Arthroscopic portals are placed through a few small incisions.
• Your surgeon performs diagnostic arthroscopy to confirm the extent of bone overgrowth and cartilage damage.
• Debridement, or cleaning out the bone tissue, frayed cartilage or loose fragments, is performed using a surgical shaver.
• Labral reconstruction using tissue grafts may be performed to repair a damaged labrum, the rubbery tissue that keeps the ball of the joint in place.
• Once the repair is complete, the arthroscope and instruments are removed, the incisions are closed, and a bandage is applied.

Postoperative Care and Instructions

In general, postoperative care instructions and recovery after osteochondroplasty will involve the following steps:

• You will be transferred to the recovery area where your nurse will closely observe you for any allergic/anesthetic reactions and monitor your vital signs as you recover.
• You may need to stay in the hospital for a day or two before discharge to home.
• You may notice some pain, swelling, and discomfort in the operated area. Pain and anti-inflammatory medications are provided as needed.
• You will be placed on assistive devices such as crutches with instructions on restricted weight-bearing for a specified period of time. You are encouraged to walk with assistance as frequently as possible to prevent blood clots.
• Keep the surgical site clean and dry. Instructions on surgical site care and bathing will be provided.
• Refrain from smoking as it can negatively affect the healing process.
• Refrain from strenuous activities for the first few months and lifting heavy weights for at least 6 months. Gradual increase in activities over a period of time is recommended.
• An individualized physical therapy protocol will be designed to help strengthen hip muscles and optimize hip function.
• Most patients are able to resume their normal activities in 3 to 4 weeks after surgery; however, return to sports may take at least 6 months or longer.
• Refrain from driving until you are fully fit and receive your doctor’s consent.
• A periodic follow-up appointment will be scheduled to monitor your progress.

Risks and Complications

Osteochondroplasty is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as the following:  

• Infection
• Bleeding
• Postoperative pain
• Damage to nerves and vessels
• Damage to joint cartilage or the labrum
• Thromboembolism or blood clots
• Anesthetic reactions