terioration uniformly begins laterally on the acetabu-lar side and then secondarily involves the femoral head. Occasionally, grade IV acetabular lesions with healthy surrounding articular cartilage may be candidates for microfracture and represent a small subpopulation of patients who may respond remarkably well. The postoperative rehabilitation protocol for this procedure includes 10 weeks of strict protective weight bearing, with emphasis on range of motion during the early fibrocartilaginous healing phase.
Another pattern of primary osteoarthritis begins with articular wear on the medial aspect of the femoral head. Radiographs demonstrate medial joint space narrowing and often remarkably good preservation of the superior weight-bearing surface (Figure 2.15A). The ar-throscopic findings are consistent with the radiographic findings. The most lateral articular surface of the femoral head is remarkably well preserved, but the entire medial half is void of articular surface with eburnated bone and similar findings on the medial aspect of the acetabulum (Figure 2.15B,C). The principal feature is not to be encouraged by the apparent superior joint space preservation because the results of arthroscopy, again, do not appear to be superior to other causes of arthritis.
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