Subchondral Cysts Treatment Options

What are subchondral cysts?

Acetabular subchondral cysts, characterized by the formation of fluid-filled cavities within the hip joint’s subchondral bone, can cause significant pain and functional impairment. While the management of these cysts depends on various factors such as the size of the cysts, severity of symptoms, and underlying joint pathology, several treatment options are available to address the condition. This discussion delves into the diverse approaches to treating acetabular subchondral cysts, ranging from conservative measures to surgical interventions.

What non-operative options are available?

In cases where acetabular subchondral cysts are small and asymptomatic, or when the symptoms are mild, conservative management strategies may suffice. These conservative approaches aim to alleviate symptoms, improve joint function, and prevent further degeneration of the hip joint. Key components of conservative management include:

1. Lifestyle Modifications: Lifestyle changes, such as adopting low-impact exercise routines, can help reduce the stress placed on the hip joint. Maintaining a healthy weight can alleviate pressure on the joint and may slow down the progression of osteoarthritis, a common underlying cause of acetabular subchondral cysts.
2. Physical Therapy: Physical therapy plays a crucial role in managing acetabular subchondral cysts. A physical therapist can design a tailored exercise program aimed at strengthening the muscles around the hip joint, improving flexibility, and enhancing joint stability. Physical therapy may also include modalities such as heat or ice therapy, electrical stimulation, and manual therapy techniques to alleviate pain and improve mobility.
3. Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) are often prescribed to manage pain and inflammation associated with acetabular subchondral cysts. These medications can help reduce discomfort and improve joint function, allowing individuals to engage in physical therapy and other conservative treatments more effectively.
4. Activity Modification: Avoiding high-impact activities that exacerbate hip pain and discomfort can be beneficial for individuals with acetabular subchondral cysts. Engaging in low-impact exercises such as swimming, cycling, or walking on flat surfaces can help maintain joint mobility without placing excessive stress on the hip joint.
5. Intra-articular Injections: In some cases, healthcare providers may recommend intra-articular injections to manage pain and inflammation associated with acetabular subchondral cysts. Corticosteroid injections or hyaluronic acid injections can provide temporary relief by reducing inflammation within the joint and lubricating the cartilage surfaces.

While conservative management approaches can effectively alleviate symptoms and improve joint function in many cases, they may not be sufficient for individuals with severe or refractory symptoms.

What surgical interventions are available?

For individuals who experience persistent symptoms despite conservative management or have larger acetabular subchondral cysts that are causing significant joint dysfunction, minimally invasive procedures may be considered. These procedures aim to address the underlying pathology of the cysts and alleviate associated symptoms. Common minimally invasive procedures for acetabular subchondral cysts include:

1. Cyst Aspiration: Cyst aspiration, also known as joint aspiration, involves using a needle to remove fluid from the cyst within the hip joint. This procedure can provide temporary relief by reducing the size of the cyst and alleviating pressure on surrounding structures. Cyst aspiration may be performed under ultrasound or fluoroscopic guidance to ensure accurate placement of the needle.
2. Subchondroplasty: Acetabular subchondroplasty is a minimally invasive procedure designed to address acetabular subchondral cysts and associated hip pain. During this procedure, a bone substitute material, typically calcium phosphate or calcium sulfate, is injected into the subchondral bone defect under fluoroscopic guidance. The injected material fills the cyst cavity, providing structural support and promoting bone healing. Acetabular subchondroplasty aims to alleviate pain, improve joint function, and potentially delay or prevent the progression of osteoarthritis in the hip joint. Minimally invasive procedures offer several advantages over traditional open surgery, including smaller incisions, reduced postoperative pain, shorter recovery times, and lower risk of complications. However, these procedures may not be suitable for all individuals, particularly those with extensive joint damage or complex cyst anatomy.
3. Hip Arthroplasty: Total hip arthroplasty (THA), also known as hip replacement surgery, may be recommended for individuals with end-stage osteoarthritis or severe joint damage secondary to acetabular subchondral cysts. During THA, the damaged hip joint is replaced with an artificial prosthesis made of metal, plastic, or ceramic components. Hip arthroplasty can provide significant pain relief and improve joint function, restoring mobility and quality of life for affected individuals.

What does the post-operative rehabilitation look like?

Regardless of the treatment approach chosen, postoperative rehabilitation is essential for optimizing outcomes and promoting long-term joint health. Following surgical intervention, individuals will undergo a structured rehabilitation program under the guidance of Dr. Shane J. Nho and a physical therapist. Postoperative rehabilitation aims to:

1. Promote Healing: Rehabilitation exercises and techniques help promote healing, reduce inflammation, and optimize tissue repair following surgery.
2. Restore Mobility: Physical therapy exercises focus on improving joint range of motion, flexibility, and functional mobility, allowing individuals to regain independence in daily activities.
3. Strengthen Muscles: Strengthening exercises target the muscles surrounding the hip joint, enhancing joint stability and reducing the risk of future injury or recurrence of symptoms.
4. Address Functional Limitations: Rehabilitation programs are tailored to address specific functional limitations and goals, helping individuals return to their desired level of activity and participation in sports, work, and recreational pursuits.

Postoperative rehabilitation will vary depending on the type of procedure performed, the extent of joint damage, and individual patient factors. Compliance with rehabilitation protocols and active participation in therapy sessions are crucial for achieving optimal outcomes and maximizing the benefits of treatment.

Dr. Shane J. Nho is a board-certified fellowship trained sports medicine orthopaedic surgeon who specializes in the treatment of subchondral cysts. If you believe you are affected by a subchondral cyst schedule a consultation today with our experienced orthopaedic care team.