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Bone cysts in the hip occur most commonly in the setting of femoroacetabular impingement (FAI), hip instability (dysplasia), and arthritis. In addition to treating the underlying problem, decompression and bone grafting of the cyst can help alleviate pain and prevent further erosion of the fluid into the adjacent healthy bone. Historically, this has been accomplished by indirect means, using additional incisions and surgical dissection to gain access to the space behind the cyst for drilling and bone grafting.
Recently, we developed and published a technique to decompress and bone graft cysts in the hip socket directly through the central aspect of the hip using hip arthroscopy.
The bone cyst seen in the above image is located centrally within the hip socket due to hip instability from excessive femoral antetorsion. The rotational malalignment of the femur bone contributes to excessive “play” in the hip resulting in shear forces on the surface cartilage. With continued instability, the cartilage becomes delaminated from the underlying bone and allows fluid to enter and form a cyst. The treatment entails removal of the overlying loose cartilage, decompression of the cyst, and insertion of bone graft using a curved device, as shown in the images below:
Although this technique is minimally invasive and can alleviate the pain coming from the cyst, it is important to also treat the underlying problem to ensure that the cyst does not recur. In this case, the patient underwent a derotational femoral osteotomy (DFO), following cyst healing, to address the femoral antetorsion as pictured here:
At SCHI we are actively studying the effects of bony alignment on hip pathology and the need for corrective surgery. Our goal is to provide the least invasive treatment option to get rid of your pain and get you back to the active lifestyle that you enjoy!
Dr. Tigran Garabekyan is a board certified orthopedic surgeon specializing in hip preservation. To learn more about Southern California Hip Institute or to schedule a consultation, click here to contact us. Serving patients in Encino, Sherman Oaks, Van Nuys, North Hollywood, Burbank, Glendale, West Hollywood, Century City, Beverly Hills, Santa Monica, Los Angeles, and other neighboring cities in the greater Los Angeles area.
