Hip

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 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

Symptoms — do you recognize these?

Chondral defects do not produce a uniform symptom pattern, and many early lesions are asymptomatic:

Deep groin pain, often associated with activity and relieved by rest
Mechanical symptoms: catching, clicking, locking (more specific for free chondral fragments or loose bodies)
Pain with pivoting, squatting, or hip flexion activities
Stiffness and aching after prolonged activity
Symptoms may be indistinguishable from labral tear or FAI until arthroscopy is performed

Call us at (301) 515-0900. Same-day appointments available at our Bethesda and Germantown locations.

How we diagnose it

Standard MRI has limited sensitivity for small hip cartilage defects. Advanced imaging is required:

MRI arthrogram (MRA): Intra-articular gadolinium contrast distends the joint and markedly improves detection of chondral lesions and associated labral tears. MRA is the preferred study at MOS for suspected hip chondral pathology. It characterizes:

Location and extent of cartilage loss
Status of the labrum (tear, degeneration)
Underlying FAI morphology (cam or pincer)
Subchondral bone involvement

High-resolution 3T MRI: Non-contrast 3T MRI with cartilage-specific sequences (DESS, T2 mapping, delayed gadolinium-enhanced MRI of cartilage, or dGEMRIC) can provide cartilage quality information without injection; available at select centers.

X-rays: AP pelvis and Dunn lateral views assess for FAI bony morphology (alpha angle, lateral center-edge angle, crossover sign) and rule out early joint-space narrowing indicating diffuse OA.

Hip arthroscopy: Definitive assessment of cartilage quality and extent occurs at arthroscopy, where direct visual and probe-based evaluation under anesthesia provides real-time information to guide intra-operative decisions.

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

Surgical Procedure

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.

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Recovery & rehabilitation

Recovery varies substantially by procedure:

Chondroplasty only: Weight-bearing as tolerated; return to light activity 6–8 weeks
Microfracture: Flat-foot weight-bearing only (20 lbs) for 6–8 weeks; CPM machine daily for 6 weeks; return to sport 4–6 months
MACI: Touch-down weight-bearing 6 weeks; progressive rehabilitation 6–18 months; return to high-impact sport at 12–18 months
Osteochondral allograft: Protected weight-bearing 6–8 weeks; return to sport 9–12 months

Frequently Asked Questions

If I have a labral tear and a cartilage defect, will both be treated at the same time?

Yes. Dr. Christoforetti addresses all pathology identified at arthroscopy in a single procedure whenever possible: labral repair, FAI correction (femoroplasty/acetabuloplasty), and cartilage restoration.

Does hip cartilage surgery prevent arthritis?

The goal is to preserve function and delay or prevent joint-space narrowing in younger patients. Outcomes depend on the size and location of the lesion, the presence of underlying mechanical correction, and patient compliance with rehabilitation. Large defects or advanced age increase the risk of eventual OA.

How does microfracture in the hip compare to the knee?

Hip microfracture outcomes are comparable to knee microfracture for small, contained lesions, but the hip's spherical geometry and higher contact pressures make rehabilitation more demanding. The non-weight-bearing protocol is strictly followed to allow clot formation.

Am I a candidate for cartilage restoration if I'm over 50?

Age is not an absolute contraindication, but outcomes are better in patients under 40 with localized defects and no diffuse joint-space narrowing. Patients over 50 with extensive cartilage loss may be better served by hip replacement.

How long is recovery after hip cartilage surgery, and when can I return to sport?

Recovery after hip arthroscopy for cartilage defects typically takes four to six months for return to sport, though procedures involving microfracture require strict protected weight-bearing for six to eight weeks to allow fibrocartilage formation. Patients who have had cartilage grafting or autologous chondrocyte implantation in the hip may need up to twelve months before full athletic activity. Your MOS surgeon will use a structured, phase-based rehabilitation program and will not clear you for return to sport until strength and functional movement benchmarks are met. Adhering to the rehabilitation timeline is essential to maximize the durability of the cartilage repair.

Meet the specialists

John J. Christoforetti, MD

Orthopedic Surgery · Sports Medicine · Hip, Knee & Shoulder Arthroscopy · Shoulder Replacement

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Medically reviewed by John J. Christoforetti, MD, FAAOS

Last reviewed May 1, 2026

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/