What is the recommended treatment for left hip arthrosis with extensive degenerative labral tearing and high-grade partial thickness chondral loss?

From the Guidelines

The recommended treatment for left hip arthrosis with extensive degenerative labral tearing and high-grade partial thickness chondral loss is total hip arthroplasty, as it offers the most reliable long-term outcomes by replacing both the acetabular and femoral components of the damaged joint. This approach is supported by the most recent and highest quality study, which emphasizes the importance of individualized treatment based on the patient's current signs and symptoms, as well as their characteristics, including comorbidities and psychosocial factors 1.

Initial Treatment

Initial treatment includes:

• Oral NSAIDs, such as ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily), for pain and inflammation
• Physical therapy focusing on hip strengthening, core stability, and range of motion exercises performed 2-3 times weekly for 6-8 weeks
• Activity modification to avoid high-impact activities
• Intra-articular corticosteroid injections (typically methylprednisolone 40-80mg with lidocaine) for temporary relief, limited to 3-4 injections yearly
• Hyaluronic acid injections for longer-lasting relief
• Weight loss, as each pound lost reduces hip joint pressure by 3-6 pounds, is strongly recommended for overweight patients

Surgical Intervention

For patients with persistent severe symptoms despite conservative measures, surgical intervention may be necessary. Total hip arthroplasty is the definitive treatment for advanced arthrosis, offering the most reliable long-term outcomes by replacing both the acetabular and femoral components of the damaged joint. The treatment choice depends on the patient's age, activity level, symptom severity, and functional limitations, with the goal of reducing pain and improving function while delaying joint replacement when appropriate 1.

Key Considerations

Key considerations in the treatment of left hip arthrosis with extensive degenerative labral tearing and high-grade partial thickness chondral loss include:

• Individualized treatment based on the patient's current signs and symptoms, as well as their characteristics, including comorbidities and psychosocial factors
• The importance of delaying joint replacement when possible, while also considering the patient's quality of life and functional limitations
• The potential benefits and risks of surgical intervention, including total hip arthroplasty, and the need for careful patient selection and preoperative planning.

From the Research

Treatment Options for Left Hip Arthrosis

• The recommended treatment for left hip arthrosis with extensive degenerative labral tearing and high-grade partial thickness chondral loss is hip arthroscopy 2, 3, 4.
• Hip arthroscopy is a minimally invasive procedure that can be used to evaluate, diagnose, and treat acetabular labral and chondral lesions 2.
• Arthroscopic treatment of labral tears involves judicious debridement back to a stable base while carefully preserving the capsular labral tissue 2.
• Chondral defects can be drilled or treated with a microfracture technique to enhance fibrocartilage formation 2.

Conservative Treatment

• Conservative treatment may include relative rest, non-steroid anti-inflammatory agents, and physical therapy (PT) 3, 4.
• However, intra-articular cortisone injection has limited therapeutic benefits for patients with femoro-acetabular impingement and labral tear 5.
• Conservative treatment may be considered as an initial approach, but surgical treatment may be necessary if symptoms persist 3, 4.

Surgical Treatment

• Surgical treatment may involve labral debridement, labral repair, or labral reconstruction 4.
• Arthroscopy is the gold standard for the diagnosis and treatment of labral tears 2, 3, 4.
• The outcome of surgical treatment is directly dependent on the stage or extent of the labral and chondral lesion 2.