Your Guide To Hip Preservation
Hip joint preservation allows patients to be pain-free and high functioning while saving their hip joint from replacement surgery.
Sometimes simpler pathologies like hip flexor bursitis, greater trochanteric bursitis, iliotibial band syndrome (IT band syndrome), or a snapping hip can limit patients from performing activities they enjoy. These hip pathologies are termed external hip pathologies. I can often treat hip pathologies with non-surgical methods, including physical therapy, myofascial release, corticosteroid injections, platelet-rich plasma injections, ultrasound treatment, softwave therapy, hip mobility exercises, nutrition, and a thorough home exercise program.
At times, other hip pathologies such as hip acetabular labrum tears, femoroacetabular impingement (FAI), chondral flap or defects (focal cartilage damage), loose bodies (floating cartilage or bone pieces), synovitis, osteonecrosis or avascular necrosis (AVN), hip dysplasia, and osteoarthritis can limit patients. These hip pathologies are termed internal hip pathologies.
Conservative Treatments
At times, non-surgical treatments such as corticosteroid injections, platelet-rich plasma injections, softwave therapy, hip mobility exercises, nutrition, and physical therapy can help manage the symptoms of internal hip pathologies. However, surgical treatment offers the only cure because these internal hip pathologies are structural problems in the hip. Although not all patients with these internal hip pathologies require surgery, a significant percentage will require surgical treatment to correct these issues.
Interestingly, patients are always surprised to learn that the most common cause of hip osteoarthritis needing a hip replacement is a hip labral tear with femoroacetabular impingement (FAI).
Why Is Hip Preservation Important?
Many people worldwide choose to live with pain in their hips and stiffness and limit the activities they enjoy. As months and years go by, many patients realize exactly how limited they have become. Sometimes, these patients are in their late teenage years to mid-30s, often the most high-functioning times. Other times, these patients are in their 40s, 50s, and 60s, a time to return to activities they enjoy as life may be more balanced.
Hip preservation is essential to allow patients with limiting hip pain to live pain-free and perform activities they enjoy both pain relief and improved function while preserving the hip joint. When surgical treatment is required, repairing and correcting hip problems may prevent the formation or progression of hip osteoarthritis.
Early Evaluation & Diagnosis
Recognizing and evaluating hip issues early on, with the guidance of a specialist, is crucial. Non-surgical treatment in the early stages can prevent prolonged pain and worsening of symptoms for most external hip pathologies. Similarly, early non-surgical treatment can also prevent internal hip pathologies from worsening and developing into hip osteoarthritis. In some cases, surgical treatment may be necessary for internal hip pathologies such as labrum tears or femoroacetabular impingement.
If surgery is needed, in addition to repairing and correcting the hip pathology, it may prevent or delay hip osteoarthritis progression.
Patients are always surprised to learn that the most common cause of hip osteoarthritis needing a hip replacement is an existing hip labrum tear with femoroacetabular impingement (FAI).
Is There Hip Preservation Surgery?
Hip preservation surgery is in tremendous need and includes the following procedures: hip arthroscopy, hip core decompression, periacetabular osteotomy (PAO or Ganz osteotomy), and surgical dislocation. Hip arthroscopy is the most popular.
Hip Arthroscopy
Hip arthroscopy is a technically challenging procedure that well-trained surgeons should only perform, and the outcome is directly dependent on surgeon expertise and surgical indications. It is performed using two to four arthroscopic incisions measuring 5-8mm. An arthroscope (camera) is used to visualize the hip joint, and instruments are used to treat internal hip pathologies such as repairing the labrum tear, correcting femoroacetabular impingement (FAI), resecting synovitis, debriding the cartilage flap, and excising loose bodies. Hip arthroscopy is very successful when performed correctly, efficiently, for the right reason, and with the right physical therapy.
Hip Core Decompression
Hip core decompression (femoral head core decompression) is performed in conjunction with or separate from hip arthroscopy. It is performed for hip osteonecrosis or avascular necrosis (AVN). Using a 1-inch incision, the femur is drilled to help revascularize the femoral head (regrow blood supply). It is most successful in smaller affected lesions in the femoral head without significant osteoarthritis.
Periacetabular Osteotomy
Periacetabular osteotomy (PAO or Ganz osteotomy) is a three-dimensional restructuring of the hip acetabulum to improve femoral head coverage, usually done to correct hip dysplasia. It is a complex, open surgery traditionally performed for patients in their early 30s and younger years. It can also be performed in conjunction with hip arthroscopy.
Surgical Dislocation
Surgical dislocation is an open surgery to correct global femoroacetabular impingement (FAI). It is performed less often now as hip arthroscopy has become more adept at managing FAI.
How Does Hip Preservation Compare To A Total Hip Replacement?
A total hip replacement uses metallic implants to replace the hip joint with the new bearing surface, usually ceramic on highly crosslinked polyethylene.
Hip preservation procedures serve to maintain the natural hip joint without replacing structures. Rather than replacing the hip joint, the natural hip anatomy is corrected or repaired. The goal of hip preservation surgery is to allow resolution of pain, improvement in function, and maintain the hip joint to avoid hip replacement surgery.
