While total hip replacement is the most common hip surgery, there are a number of other surgical interventions to relieve hip pain of various genesis. As is discussed elsewhere on this site, arthritis is the main cause of hip replacement but there can be many other hip conditions, both traumatic and chronic, even congenital. For those conditions, surgeons may consider core decompression, osteotomy or arthroscopy.
Core decompression is an intervention used when lack of blood flow to the head of the femur results in avascular necrosis (AVN) or bone death. The result of AVN is general deterioration of the hip joint otherwise described as arthritis.
In a core decompression, the surgeon will drill a channel through the femoral neck (at the top end of the femur) into the necrotic (dead) area in the head. He will then insert into this a bone graft taken from the patient’s shin complete with some small sections of blood vessels. The bone graft is placed into the drill channel and the blood vessels sutured to vessels in the thigh to allow the bone graft to thrive and re-establish a blood supply to the head of the femur.
Core decompression is optimal for those in the earliest stages of avascular necrosis. Its objective is to slow progression of bone degeneration and reduce pain.
When the problem is the result of dysplasia, (a misshapen or shallow acetabulum or femoral head) the pelvic bone is divided (cut) and the angle adjusted in various ways to improve the joint stability. If arthritic changes are present, this can also provide a less damaged area of cartilage to the weight bearing portion, thus reducing pain and disability.The division in the bone is secured with pins or screws.
There are different hip osteotomy procedures, depending on the type of bone correction required.
In a hip arthroscopy, the surgeon will insert a fiber optic camera into a small incision at the joint along with a surgical instrument. Generally, an arthroscopy is performed to clean out (or debride) bone spurs or cartilage tear at the acetabulum.
The acetabular labrum is a horseshoe-shaped cartilage attached to the outer edge of the acetabulum (hip socket) that adds depth to the hip joint. It provides additional stability to the hip.It can occur acutely or degeneratively. A tear can even occur if the hip socket is shallow.
Recovery from a hip scope is generally quick – but the camera often uncovers the need for osteotomy or total hip replacement.
image credit: phalinn