New procedure may help delay hip replacement
After an MRI found damage to the bone on the ball side of his left hip joint, doctors recommended that Ted DeFrancisco rest the area by using crutches for several months.
That didn’t cut it for the 49-year-old Marysville
resident, who makes a living on his feet managing the restoration of properties damaged by water and fire. Something had to give. “I couldn’t do anything,” he said. “I couldn’t put any weight on my leg whatsoever.”
Because of DeFrancisco’s relatively young age, his orthopedic surgeon, Dr. Kelton Vasileff, shied away from hip-replacement surgery.
Vasileff, who specializes in hip preservation at Ohio State University’s Wexner Medical Center, turned instead to something called the Subchondroplasty Procedure.
The process inserts a cement-like bone substitute into damaged bone to fill any lesions or voids.
While it’s gained popularity over the past several years as a way to help heal knee injuries, it’s rarely used for hip
joints, Vasileff said.
But he started using Subchondroplasty for hip repair within the past year and has now performed the procedure as many as 20 patients. He said it can target cysts, swelling or other damage in the bone.
“The idea is if we can help treat the bone underneath the cartilage ... on the socket side or on the ball side, then we can hopefully help those patients preserve their hip for longer,” he said.
Vasileff said he mixes the cement-like bone substitute with healing factors and proteins pulled from a patient’s bone marrow. The substance is then injected into the “more hollow, spongy, spiderwebby” interior bone, where it eventually hardens, he said.
“It then supports the bone,” Vasileff said “Your bone then grows into it over time and replaces it with your
own healthy bone.”
Before injecting the bone substitute, Vasileff said, he drills several holes in the bone to reduce pressure and stimulate bleeding, which attracts healing elements to the area.
In DeFrancisco’s case, the damage was to his femoral head, the bone at the top of the leg that forms the ball side of the hip joint.
DeFrancisco said the outpatient procedure, which he underwent in August, was a success. After recovery and physical therapy, he was back to work “full force” by the end of October.
Vasileff called the surgery “a home run.”
“He got back to work way faster than he would have with just crutches, and he didn’t need a hip-replacement surgery, so to me that was a big win for him,” Vasileff said.
While hip Subchondroplasty is too new for Vasileff to comment on any long-term outcomes, he said the procedure has proven durable in knee surgeries.
He cautioned that it is not a cure for arthritis and that there is a narrow category of patients for whom it is appropriate.
It’s most helpful, he said, for patients who still have relatively intact cartilage on both sides of the joint but damage or cysts in the bone underneath that cartilage. Often, the procedure is paired with other hip-preservation techniques, such as reshaping bone and clearing or repairing cartilage. He said insurance has been providing coverage.
“If we can do the Subchodroplasty, maybe it helps support their bone better. Maybe that bone heals, it gives them support, they do OK, and we kick that can down the road — for that hip replacement — longer,” Vasileff said.
“If this is something that can prolong things significantly, then I think it’s worth it.”