Working in the hip presents a few technical challenges that are different than those found in the knee. One of the more difficult obstacles is the ability to access different parts of the hip with an instrument and create microfracture holes that are perpendicular to the cartilage surface. Various companies are vested in the development of devices that can help surgeons overcome these obstacles.

Stryker (Mahwah, NJ) has developed a MicroFX^TM OCD system with multiple curette and microfracture guide options to facilitate access to different parts of the hip. Their curettes are ring, pear, and reverse triangle shaped to help create vertical shoulders that are mechanically stable. The guides have angled necks including 0°, 45°, 70°, and 90°. The working lengths of the curettes and microfracture guides are 3.5 and 7 in. in length. Snap caps can be used with the guides and are available in 4-, 5-, 6-, and 7-mm options to allow surgeons to choose an appropriate depth of microfracture (Fig. 3). The drill has a 2-mm tip with flutes to allow for bone extraction rather than compaction. Extracting bone leaves clear channels for the efflux of marrow cells [13] (Fig. 4). The microfracture guide has a mouth that has teeth to reduce the risk of skiving (Fig. 5).

Smith & Nephew (Andover, MA) has developed an XL Microfracture Pick that is added to its hip instruments tray (Fig. 6). The pick has an angle of 90° (Fig. 7). The pick has a mid-shaft strike point allowing for the 90° angle pick to be impacted with a perpendicular force into the subchondral bone (Fig. 8). This mid-shaft strike point also helps minimize the chances of skiving. The shaft is tapered and has a working length of 15.2 in., thus allowing it to be used with a slotted cannula in a standard arthroscopy portal.