There are many surgical procedures that can be used depending on the findings. All of them can be carried out arthroscopically, i.e. through small incisions:
If a piece of cartilage and bone has broken off (usually in an accident), it can be fixed with pins. This method is called refixation.
Worn areas of cartilage can be smoothed during arthroscopy by so-called debridement. Cartilage-degrading enzymes and loose pieces of cartilage can also be flushed out with this method. However, the procedure does not heal the joint, it only relieves symptoms for a limited time.
Pridie drilling is a method that stimulates the bone marrow. During arthroscopy, holes are drilled into the damaged cartilage. This causes bleeding from the bone marrow, which forms fibrin clots on the defect. From these, a fibrous replacement cartilage develops. Because of its negative effect on the area around the drill holes, this method is rarely used today.
Pridie drilling has been replaced by microfracture. The bone is opened with a special instrument; after bleeding, a fibrous replacement cartilage also develops here. With movement therapy after the arthroscopy, pain and swelling can be reduced considerably.
Abrasion arthroplasty is also rarely used today. In this procedure, the exposed bone is ground down with a burr so that the load-bearing bone layer is preserved. By opening the bone marrow space, this method leads to the formation of a fibrous replacement cartilage. Here too, the improvement is usually only temporary.
In the transplantation of osteochondral autografts, cylinders of cartilage and bone are taken from less stressed areas of the joint and transplanted into the damaged area. This technique can restore the surface of the cartilage layer and the damaged bone well. However, success is usually only achieved with cartilage damage caused by accidents, not with the common degenerative (wear-related) lesions.
Autologous chondrocyte transplantation (ACT) is a new biological procedure that is being used more and more. During arthroscopy, a small cartilage sample is taken from a non-weight-bearing part of the joint. In a special laboratory, these cells are multiplied until they can fill the defect well. After about 4 weeks, the cultured cells are injected back into the joint during open joint surgery. During a rehabilitation period, high-quality regenerated cartilage grows. ACT can treat joint cartilage damage in patients aged 16 to 50. Requirements are intact cartilage around the defect, sufficient ligament stability, free joint mobility and a straight leg axis (no bow legs or knock knees). This procedure is therefore not suitable for treating osteoarthritis.
None of these procedures can be used in the hip joint.
If the cartilage damage is extensive, if there is pronounced pain (start-up pain) despite medication and quality of life is therefore restricted, the remaining option is the implantation of a prosthesis. After the operation, thorough rehabilitation is essential, and it plays a decisive role in how satisfied patients are after the operation.