It is not uncommon to read in the report of an X-ray performed because of a painful hip “sclerosis of the acetabular roofs“. Together with the reduction of the joint rhyme, this particular condition represents an indirect alteration resulting from the consumption of articular cartilage (coxarthrosis).
But what exactly does it mean and what solutions can be adopted to remedy it? Let’s find out in this article.
Sclerosis of the acetabular roofs: what does it mean?
These terms, which are definitely complex, can be confusing and do not make it easy for the patient to interpret the report correctly. Let us analyze them individually to try to better understand what we are talking about.
Acetabular roofs
The acetabular roof is the upper portion of the socket present in the hip (acetabulum) that allows insertion and accommodation of the femoral head. Together with the acetabular labrum, the roof ensures that the femur remains stationary in its socket. As the part of the hip most subject to the pressures of body weight, its integrity is put at risk by conditions such as obesity and aging.
Sclerosis
Sclerosis is the hardening of a tissue or organ usually caused by inflammatory phenomena that have had scarring outcomes. In the specific case of the acetabula, the wear and tear of cartilage (and thus its diminution) causes it to be concentrated in only a few places, creating bony thickening. It is easily visible through an X-ray.
Sclerosis of the acetabular roofs
As the cartilage begins to wear down and decrease in thickness, thejoint tries to increase its surface area so that the load is distributed to the entire subchondral bone (bone just below the cartilage), without it being concentrated in one specific spot.
Increased joint surface area occurs over the years, producing additional bone at the joint margins-these tend to look like bone spurs and are called osteophytes.
This thickening of bone is called sclerosis of the acetabular roofs and is an early sign of hip osteoarthritis or coxarthrosis.
What solutions can be adopted?
Once the status of the condition is framed through a specialist examination, any further investigations (such as an X-ray of the pelvis and hips) can be planned and subsequent treatment can be evaluated.
Obviously, possible solutions depend on the degree of cartilage wear, whether predisposing factors are present, and the age of the patient.
Conservative therapy
The first approach to reduce pain and decrease cartilage consumption is aimed at changing one’s lifestyle; this includes weight loss and low-gravity exercise (cycling, gym exercises, swimming, water exercises, yoga…).
In recent years, similar to the knee, efforts have been made to apply infiltrative therapies to the hip as well. Given its narrow joint space, however, the anatomy of the hip is less suitable for this type of treatment.
Because of this, and the fact that the hip is positioned deeper than the skin, it is preferable to perform such infiltrations with the help of an ultrasound. This makes it possible to fully center the joint and not waste the drug by injecting it into the spaces immediately near the hip.
If conservative treatments do not result in an improvement in pain or if we are facing a very advanced state of cartilage wear and tear, surgical treatment may be opted for.
Surgical treatments
For patients under 40-45 years of age with cartilage in good condition and an anatomy characterized by a femoro-acetabular conflict, it will be possible to opt for a correction of the bony anomaly under arthroscopy.
Generally, however, in those who have sclerosis of the acetabular roofs visible on radiography, cartilage wear is such that medium- to long-term benefits cannot be achieved through simple arthroscopic surgery.
If the wear of cartilage, especially of the upper portion of the acetabular roof, is advanced, associated with a reduction or disappearance of the joint rhyme, the only surgery that can achieve results is the hip replacement.
Fortunately, to date, the materials and surgical techniques used in this type of surgery allow for a complete and speedy recovery, enabling people to return to their daily activities, including sports.
Would you like to learn more about acetabular roof sclerosis or need a consultation? Please feel free to contact me.
