Hip and Knee osteoarthritis is the result of cartilage destruction of the joint. Symptoms leading to OA however may start before any changes are seen on x-ray. This is because changes often start in the subchondral region before any damage occurs at the cartilage level.

Bone marrow lesions or BMLs are strong predictors of osteoarthritic cartilage damage. Bone marrow lesions are visible on an MRI but not in a regular X-ray. BMLs are sites of chronic inflammation of subchondral bone. They lie below the surface of the bone within the marrow and are accompanied by some oedema. BMLs are associated with subchondral defects, insufficiency fractures and stress fractures.

Patients with chronic BMLs have faster cartilage destruction and are more likely to require joint replacement surgery soon.

Procedure:

Subchondroplasty is a minimally invasive procedure that is performed to specifically repair chronic BMLs by filling them with a bone substitute material. The bone substitute is then slowly resorbed and replaced with healthy bone, repairing the bone defect. Subchondroplasty also resolves the associated edema.

Before the procedure the BMLs are first diagnosed on a T2 Fat Suppressed MRI. The whole procedure is performed under fluoroscopy to accurately target the chronic BMLs. Following the procedure weight bearing is avoided for 1 to 2 weeks

The procedure is minimally invasive and can be done as an outpatient procedure. It does not hinder total joint replacement if required at a later date. Dr. Kelton Vasileff, an orthopedic surgeon at Ohio State Wexner Medical Center uses this procedure to preserve the hip joint when possible. He said the bone substitute material filling any lesion in the bone will be replaced by healthy normal bone and may lead to permanent repairs delaying the onset of osteoarthritis. Experts at Ohio State Wexner Medical Center say Subchondroplasty is also helpful for pregnant women who often suffer from temporary osteoporosis during their third trimester of pregnancy or after delivery. Without it, they’re often forced to use to crutches for months.