The indications for microfracture of the hip include focal and contained lesions, typically less than 2 to 4 cm in size. Some authors have noted that lesions less than 400 mm2 tend to respond better to microfracture than lesions 400 mm2 or greater . Other indications include full thickness loss of articular cartilage in weight-bearing areas and unstable cartilage flaps overlying intact subchondral bone. Patients with degenerative joint disease of the hip may also be candidates for this procedure, especially if the changes are focal and not extensive enough to warrant total hip arthroplasty. Other considerations for performing the procedure include patient age, activity level, and the ability to comply with the postoperative rehabilitation protocol.
Contraindications to microfracture include partial thickness defects and those chondral lesions associated with a bony defect. Those patients who are unwilling to follow the postoperative protocol should not have this procedure. Patients may not be able to effectively comply with the postoperative rehabilitation protocol if they are unable to bear weight on the contralateral leg. Some patients over the age of 60 may have difficulty using crutches to protect the treated limb. This age limit should be a relative contraindication because there are many people over the age 60 that are healthy and active and meet the preopera-tive criteria. Other specific contraindications include systemic processes such as immune-mediated disease and systemic disease induced arthritis or cartilage injury [8,9,13].
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