WHAT IS OSTEOARTHRITIS?

According to the World Health Organization and worldwide data published in 2016, 10% of men and 18% of women at the age or over the age of 60, suffer from some type of hip arthritis. The most common type is osteoarthritis which is age-related. According to recent epidemiological research, obesity, a sedentary lifestyle, smoking and alcohol consumption are additional contributing factors. Prior joint injuries and physical activities that put strain on the joints are also considered to be potential risk factors.

Osteoarthritis is caused by the breakdown of articular cartilage, the resilient and elastic tissue composed of water, collagen, protein and lipids that covers the articular surfaces of bones. The articular cartilage acts as a shock-absorber and distributes weight-bearing forces. Breakdown of articular cartilage of the hip bone happens when the acetabulum (part of the pelvis that encloses the head of the femur) rubs against the head of the femur, the ball-shaped highest part of the thigh bone. At the same time, joint stiffness is a common symptom as well as the formation of cysts and bone spurs (osteophytes).

WHAT IS THE FEMOROACETABULAR IMPINGEMENT SYNDROME?

Despite the fact that osteoarthritis is a condition that affects older individuals, recent studies have shown that the femoroacetabular impingement syndrome is common amongst young or middle-aged individuals and can be a contributing factor in the development of future osteoarthritis. Symptoms of this relatively new clinical entity include pain and a limited range of motion of the anterior, lateral, and less frequently, the posterior part of the hip bone. Anatomical features of the bone (the femoral head and acetabulum), in combination with daily physical activity, can alter the morphology of the joint, and lead to femoroacetabular impingement syndrome.

When the femoral head shows a loss of roundness and cannot rotate smoothly inside the acetabulum, the condition is called CAM impingement (CAM lesions) which is mostly associated with young male athletes. When the acetabulum rim extends over its normal size, is too deep, or has an abnormal posterior slope, it rubs against the femoral head. This condition is called Pincer impingement (Pincer lesions). Both conditions can exist at the same time leading to CAM and Pincer impingement which is the most frequent type of impingement. 

CONVENTIONAL THERAPY OR SURGERY?

Individuals who already suffer from hip osteoarthritis, as well as those diagnosed with femoroacetabular impingement syndrome, are initially recommended to reduce physical activities as well as lose weight in order to minimize joint-load. For the first time in 2017, the American Academy of Orthopaedic Surgeons published guidelines in which corticosteroid injections, physiotherapy and non-steroidal anti-inflammatory drugs were recommended before opting for surgery.

WHAT IS THE AUTOLOGOUS STEM CELL THERAPY?

For patients under the age of 60 who suffer from early-onset or moderate arthritis, conventional treatment includes autologous stem cell therapy, which is one of the most significant developments in regenerative medicine. Autologous stem cell therapy is used to prevent the progression of osteoarthritis, and at the same time, generate new stem cells to repair the joint–stem cells are self-renewing progenitors that can differentiate into other types of cells. It is a straightforward procedure: bone marrow is harvested by the doctor from the pelvis, and the stem cells are isolated. Using C-arm guidance, the stem cells are injected with precision into the affected articular cartilage.

An alternative cell source is the patient’s subcutaneous adipose tissue. In this case, before injecting the cells, a two-week period for in vitro cell culture is necessary. After the end of therapy, the patient needs to rest for 24 hours. The results become noticeable after 3 months, and significant improvement of the patient’s health is estimated to happen after almost one year. At this point, a new MRI scan is necessary in order to confirm the outcome.

WHEN TO OPT FOR SURGERY?

In relation to the patient’s age, level of physical activity, medical history, and particularly in cases of unsuccessful conventional therapy, arthroscopic surgery can provide a solution. During an arthroscopic surgical procedure, the surgeon inserts a camera through a small incision, in order to generally assess the hip joint– the aim is to eliminate painful symptoms and prevent the development of arthritis. The objective is to preserve as much of the healthy tissue as possible, remove or repair rim tears of the lip labrum, even repair tears by using absorbable sutures or fixate the acetabulum with suture anchors. Furthermore, if deemed necessary, adjoining articular cartilage tears are repaired.

Physiotherapy sessions begin immediately after surgery. The patient must use crutches for a 3 to 5 weeks period in order to reduce joint-load. Full range of motion returns 9 to 12 weeks after the surgery and the return to physical activities is estimated to be between 3 to 4 months.

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