Hip preservation surgery represents a specialized area of orthopedic medicine dedicated to repairing and restoring the function of the natural hip joint rather than replacing it with an artificial one. This approach is primarily aimed at younger, active individuals who are experiencing hip pain or dysfunction due to mechanical or structural abnormalities. The fundamental goal of these procedures is to correct the underlying anatomical problem, stabilize the existing joint anatomy, and prevent or significantly delay the onset of debilitating arthritis, thereby extending the functional lifespan of the patient’s native hip.
Conditions That Require Hip Preservation
Hip preservation surgery is often needed when the ball-and-socket joint is structurally misaligned or misshapen, leading to abnormal contact and premature wear. A common cause is Femoroacetabular Impingement (FAI), which involves bone spurs on the femoral head (cam) or the acetabulum (pincer) that collide during movement. This friction damages the surrounding cartilage and the labrum, the fibrocartilage ring that seals the joint.
Hip dysplasia is another major condition, characterized by a hip socket that is too shallow or incorrectly oriented, providing insufficient coverage for the femoral head. This lack of support places excessive stress on the rim of the socket and the labrum, destabilizing the joint and rapidly accelerating cartilage breakdown. Labral tears, which cause catching or clicking sensations, are nearly always a consequence of these underlying bony issues, requiring correction of the structural deformity for effective treatment. Early-stage avascular necrosis, where a temporary loss of blood supply causes bone tissue death in the femoral head, can also be treated with certain preservation techniques before the joint collapses.
Common Surgical Approaches
Hip preservation procedures fall into two main categories: minimally invasive arthroscopy and open osteotomy, depending on the severity and nature of the structural problem. Hip arthroscopy is a keyhole surgery that uses small incisions to insert a camera and specialized instruments into the joint. This technique is commonly used to treat FAI by trimming the bone spurs (osteoplasty) on the femoral head or socket rim, and to repair or reconstruct a torn labrum. Arthroscopy is effective for addressing soft-tissue damage and minor bony irregularities with a relatively shorter recovery period.
More complex structural deformities, such as significant hip dysplasia, require an open procedure known as a Periacetabular Osteotomy (PAO). This involves making precise cuts in the pelvic bone around the hip socket to free the acetabulum from the pelvis. The surgeon then reorients the socket to a position that provides better coverage and alignment over the femoral head, fixing it in place with screws. PAO is a more involved surgery than arthroscopy, but it is necessary to correct the mechanical instability of the dysplastic hip. Some patients with dysplasia receive a combined approach, where arthroscopy is performed alongside the PAO to address existing labral or cartilage damage that bony realignment alone would not fix.
Patient Selection and Expected Outcomes
Patient selection is crucial for success, with the ideal candidate typically being younger than 50 years old and having a high activity level. The most important predictor of a successful outcome is the condition of the joint cartilage, meaning patients must have minimal or no pre-existing arthritis. Advanced cartilage wear means the structural damage has already progressed too far, making preservation techniques less effective and often necessitating a total hip replacement instead.
The primary expected outcomes include significant pain reduction and a restored range of motion, allowing patients to return to sports and demanding physical activities. For procedures like PAO, success rates for pain relief and functional improvement range from 70% to 90%, with 70% to 80% of hips remaining functional for 10 to 20 years. The long-term objective is to prevent or delay the need for a total hip replacement, which is especially beneficial for younger individuals whose artificial joints are prone to earlier wear.
Recovery and Rehabilitation
Recovery following hip preservation surgery is a structured process that varies significantly based on the procedure performed. Patients undergoing hip arthroscopy often have a quicker recovery, while those who have a PAO face a longer and more challenging rehabilitation period. Immediately after surgery, patients are typically placed on strict weight-bearing restrictions, often requiring the use of crutches for several weeks to protect the repaired structures or the healing osteotomy sites.
Physical therapy (PT) is a mandatory component of recovery, beginning soon after the operation and focusing on regaining range of motion and strengthening the hip and core muscles. For arthroscopy, the return to light activities can begin within a few weeks, with a full return to sport or demanding activity typically taking three to six months. Recovery from a PAO is more extensive, often requiring six to twelve months before a return to full activity is possible, due to the time needed for the reoriented bone to fully heal.