Hip Articular Cartilage Defects
Articular cartilage defects of the hip — damage to the smooth, low-friction surface lining the femoral head and acetabulum — represent a challenging frontier in hip preservation. Unlike cartilage in weight-bearing areas of the knee, hip cartilage defects are difficult to detect, frequently associated with underlying mechanical problems like femoroacetabular impingement (FAI) or labral tears, and require precise surgical management. At Maryland Orthopedic Specialists, Dr. John Christoforetti — fellowship-trained hip arthroscopy specialist and past President of the International Society for Hip Arthroscopy (ISHA) — brings world-class expertise to cartilage restoration procedures of the hip.
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What is hip articular cartilage defects?
Hip articular cartilage defects are areas of damage to the smooth cartilage that lines the ball-and-socket hip joint. Because this cartilage has little blood supply, it heals poorly on its own. Defects cause pain, catching, and stiffness, and can progress toward arthritis if left untreated.
Articular cartilage is the smooth, white tissue covering the ends of bones within the hip joint. It has no blood supply of its own and very limited healing capacity. When cartilage is damaged — whether from a single traumatic event or through chronic mechanical overloading — the result is a focal defect, grade IV chondral lesion, or osteochondral defect (involving underlying bone).
Anatomy of hip chondral defects:
- Acetabular chondral lesions are more common and typically located at the anterosuperior acetabular rim — the zone of highest contact stress during hip flexion. They are very frequently associated with FAI (cam or pincer morphology) and labral tears.
- Femoral head chondral lesions occur in the zone corresponding to the acetabular lesion; often described as "kissing lesions" when both surfaces are damaged.
- Osteochondral defects involve the subchondral bone beneath the cartilage, further complicating repair.
Grading (modified Outerbridge / ICRS):
- Grade I–II: Cartilage surface intact or shallow fissuring
- Grade III: Partial-thickness defect not reaching bone
- Grade IV: Full-thickness defect exposing subchondral bone ("bare bone")
Causes:
- FAI-related mechanical wear (cam impingement produces shear forces at the acetabular rim cartilage)
- Labral tear that shifts load onto the cartilage
- Direct trauma (hip dislocation, sports impact)
- Osteochondritis dissecans (OCD) of the femoral head
- Avascular necrosis progressing to surface collapse
Treatment options
Treatment depends on the size of the defect, depth, patient age, activity level, and presence of underlying mechanical pathology. Critically, correcting any underlying FAI or labral tear is essential — cartilage repair without addressing the mechanical cause will fail.
Non-Operative Treatments
For Grade I–II lesions or patients who are not candidates for surgery: - Physical therapy: Core and hip strengthening to optimize joint mechanics; activity modification to reduce impulsive loading - Corticosteroid or PRP injection: Reduces pain and inflammation; may provide months of relief for lower-grade lesions - Activity modification: Transitioning from high-impact to low-impact exercise
Hip Arthroscopy
Minimally invasive hip scope performed at our ambulatory surgery center, addressing labral tears, cartilage defects, femoroacetabular impingement, loose bodies, and synovial disease through small portals with same-day discharge.
Click for moreFrequently Asked Questions
If I have a labral tear and a cartilage defect, will both be treated at the same time?
Does hip cartilage surgery prevent arthritis?
How does microfracture in the hip compare to the knee?
Am I a candidate for cartilage restoration if I'm over 50?
How long is recovery after hip cartilage surgery, and when can I return to sport?
Meet the specialists
John J. Christoforetti, MD
Orthopedic Surgery · Sports Medicine · Hip Preservation Surgery
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References
- Nepple JJ, Philippon MJ, Campbell KJ, et al. The hip fluid seal — part II: the effect of an acetabular labral tear, repair, resection, and reconstruction on hip stability to distraction. Knee Surg Sports Traumatol Arthrosc. 2014;22(4):730–736. https://doi.org/10.1007/s00167-013-2751-3
- Fontana A, Bistolfi A, Crova M, Rosso F, Massazza G. Arthroscopic treatment of hip chondral defects: autologous chondrocyte transplantation versus simple debridement — a pilot study. Arthroscopy. 2012;28(3):322–329. https://doi.org/10.1016/j.arthro.2011.08.304
- Steadman JR, Rodkey WG, Rodrigo JJ. Microfracture: surgical technique and rehabilitation to treat chondral defects. Clin Orthop Relat Res. 2001;(391 Suppl):S362–S369. https://doi.org/10.1097/00003086-200110001-00033
- Krych AJ, Thompson M, Knutson Z, Scoon J, Coleman SH. Arthroscopic labral repair versus selective labral debridement in female patients with femoroacetabular impingement: a prospective randomized study. Arthroscopy. 2013;29(1):46–53. https://doi.org/10.1016/j.arthro.2012.07.011
- Frisbie DD, Trotter GW, Powers BE, et al. Arthroscopic subchondral bone plate microfracture technique augments healing of large chondral defects in the radial carpal bone and medial femoral condyle of horses. Vet Surg. 1999;28(4):242–255. https://doi.org/10.1053/jvet.1999.0242
- American Academy of Orthopaedic Surgeons. Articular Cartilage Restoration. OrthoInfo. https://orthoinfo.aaos.org/en/treatment/articular-cartilage-restoration/