About a year ago, I interviewed Mr. Rishi Chana, hip preservationist, from the UK about his thoughts about hip preservation. He was working on having some research published about additional treatment options with the hope of allowing many hips to grow old gracefully and not be replaced with artificial parts. That has always been my goal for my hips, although that will remain to be seen.
Mr. Chana has studied the importance of "biologics" in the field of hip preservation and its outcomes as compared to microfracture. So, a little background. From my understanding, microfracture is a chipping away of the cartilage in the hip that is already damaged in order to create a bleeding of sorts so that the bone marrow can create a "pseudocartilage". It is not as good as the real deal, but it can suffice for some patients. However, a better option (one which is considered experimental in the U.S.) that Mr. Chana studied was the use of biologics in the field of hip preservation.
Biologics include alphabet soup - BMAC and AMIC. AMIC- Autologous Matrix Induced Chondrogenesis is essentially a microfracture with a collagen support to aide in healing. BMAC (Bone Marrow Aspirate Concentrate) is exactly what it sounds like. Bone marrow removed from your body (aspirated) and made into a concentrate and then injected into microfractured areas in your hip.
So, back to Mr. Chana's research. He and his group looked at a total of 111 patients. "Of the 111 patients, 46 patients underwent MF [microfracture] and 65 had biological reconstruction hip arthroscopy as well as cam/pincer osteoplasty and labral repair surgery" (Sobti, Baryeh, Woolf and Chana, 2020). His group compared the patients with their pre-operative baselines and their outcome data. They also ensured that the groups were similar to each other as far as patient characteristics (age, gender and Tonnis scores).
The results showed, given the similarities of the patients, that the group that received the BMAC and AMIC did much better. 32.6% of the patients that had the microfracture ended up needing a hip replacement within 18 months. However, those patients with the biologic reconstruction (BMAC+AMIC) had much better stats. 0% of this group of patients had any failure within that 18 month period which required a hip replacement.
The other consideration is that, for most of us hippies, we have two hips that are not ideal. The use of the BMAC + AMIC (otherwise known as biologic reconstruction) allows less down time and less non-weightbearing. What that means is that you can schedule both hips relatively close together and begin your hip healing journey quicker. Again, this is still considered experimental in the U.S., but when I asked Mr. Chana about the status of the UK medical system paying for this, he indicated that "yes" they do pay for it.
This treatment option definitely gives additional options currently in the U.K. and hopefully with further research in other countries, it will become the standard of care. It is definitely a reason to remain a hopeful hippie!
Sobti, A. S., Baryeh, K. W., Woolf, R., & Chana, R. (2020). Autologous matrix-induced
chondrogenesis and bone marrow aspirate concentrate compared with microfracture
for arthroscopic treatment of femoroacetabular impingement and chondral lesions of
the hip: Bridging the osteoarthritis gap and facilitating enhanced recovery. Journal of
Hip Preservation Surgery. doi:10.1093/jhps/hnaa047