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Hip Preservation Surgery: Conditions and Treatments

The hip, similar to other areas of the body, is subject to congenital, developmental, and post-traumatic conditions. If left untreated, these conditions can lead to pain, arthritis, and potentially a hip replacement early in life. The goal of hip preservation is to prevent or delay the early onset of arthritis or the need for a joint replacement.

Hip preservation treats a full spectrum of hip disorders, including but not limited to: labral tears, hip impingement, hip dysplasia, and osteoarthritis. Candidates for hip preservation include newborns up to people age 45. Young athletes whose activities involve extreme hip motions—such as golf, hockey, gymnastics, soccer, long distance running, or cycling—would benefit from preservation techniques, in particular. Hip preservation is rapidly evolving and the latest arthroscopic techniques allow for a broad range of patients, including high-performance athletes, to maintain normal hip function.

This article contains a list of conditions that can be addressed with hip preservation surgery. Please note that this is only intended as a guide. Only a qualified orthopaedic specialist can accurately diagnose your condition and recommend a treatment plan. For a comprehensive evaluation of your hip pain, schedule an appointment with Dr. Steve Hamilton at Beacon Orthopaedics & Sports Medicine.

Conditions Treated by Hip Preservation

Labral Tears

The hip is a ball and socket joint. The head of the femur (thigh bone) forms a ball that fits into cup-shaped socket of the acetabulum (socket). The labrum is fibrocartilage (rubbery tissue) that lines the rim of the socket and provides a seal that helps keep the femur in position. This cartilage can be torn from the joint, causing pain or ache in the groin or deep in the buttock region. It can also cause the leg to feel like it is “catching” or “clicking” in the hip socket as it moves.

A labral tear can result from a single instance of acute trauma—such as a fall—or years of repetitive minor injuries. It is important to note that a tear can occur even if no pain is experienced so it is important to consult an orthopaedist following an injury or if you engage in activities that repetitively use your hip.

Some tears, especially those that cause severe pain or involve a clicking sensation, require surgery to reattach the labrum and occasionally remove torn sections.

Femoroacetabular Impingement (FAI)

Femoroacetabular impingement (FAI), also known as hip impingement, is a condition in which a structural abnormality in the hip joint causes harmful friction between the femoral head and the acetabulum. Hip impingement is classified into three types depending on the location of the abnormality:

  • Cam impingement occurs when excessive bone growth occurs at the edge of the femoral head. The growth causes a bump which can prevent the femoral head from fully rotating in its socket and also cause it wear down hip cartilage.
  • Pincer impingement occurs when excessive bone growth occurs at the edge of the hip’s socket. The growth causes an overhang which can prevent the femoral head from fully rotating and also pinch the hip’s labrum. In fact, the vast majority of labral tears are caused by FAI.
  • Combined impingement occurs when both pincer and cam impingement is present.

Many cases of FAI can be treated with arthroscopic surgery. During the procedure, the surgeon will trim or shave the abnormal bone growth. Only severe cases of FAI require open surgery.

Hip Dysplasia

Hip dysplasia is characterized by general hip instability and a higher risk of dislocation caused by a hip socket that is too shallow to support the ball of the hip. The condition can either be bilateral, meaning that both hip joints are affected, or unilateral, meaning that only one joint shows deformity. In the case of unilateral dysplasia, the left hip is more likely to be affected.

Hip dysplasia can damage the cartilage lining the joint as well as the rim of the socket, causing the hip to eventually wear out and become arthritic. Patients with dysplasia who experience pain are candidates for preservative surgery. Periacetabular osteotomy (PAO), in particular, has been shown to be effective in preserving the longevity of the hip in both youth and adults. The surgery includes a series of small cuts around the acetabulum, and rarely the upper femur, to better position the ball of the hip joint.

Osteoarthritis

Osteoarthritis, or “wear and tear” arthritis, is commonly associated with patients who are middle age or older. Post-traumatic arthritis, however, is becoming increasingly common among younger patients. Post-traumatic arthritis is a specific form of osteoarthritis that results from an injury and causes the cartilage in the hip joint to gradually wear away over time. Athletes, in particular, face a significantly higher risk of sustaining an injury that triggers the onset of the disease. Of course, these types of injuries are not limited to athletes. Slipping on ice or an automobile accident can also harm the hip joint. It is crucial to see an orthopaedist following any of these types of injuries.

There is no cure for osteoarthritis and it gradually worsens over time. Physical therapy, medications, and injections can help a patient manage their symptoms, especially if treatment is started early. If left untreated, osteoarthritis can lead to a number of serious complications, including bone spurs, damaged tendons and ligaments, and osteonecrosis.

Treatments Associated with Hip Preservation

Hip preservation involves multi-disciplinary techniques, including:

  • Physical therapy
  • Anti-inflammatories
  • Injections
  • Arthroscopy

Physical therapy is a crucial component of any treatment plan. Physical therapy helps strengthen muscles, increase flexibility, restore range of motion in the joint, and can help ease pain. A physical therapist will also teach patients proper body mechanics and ways to modify their activities in order to reduce their pain and prevent further injury.

Anti-inflammatories, or non-steroidal anti-inflammatory drugs (NSAIDS), are used to treat mild to moderate pain and inflammation. Injections, although commonly used to establish a diagnosis, can also be used to alleviate pain for certain conditions.

In some instances, surgery may be required. Periacetabular osteotomy, femoral osteotomy, acetabuloplasty, osteochondroplasty, and abductor repairs have all been shown to be effective in preserving the hip. An orthopaedic surgeon will determine when surgery is needed and recommend the appropriate procedure.

Diagnosing Hip Pain

The symptoms associated with these conditions can begin relatively mild and remain undetected for years. In fact, some adults never know they have a hip problem until severe pain develops. By this point, it may be too late to preserve the joint and a hip replacement becomes necessary.

Early diagnosis and treatment are key for preserving the hip joint and can prevent future joint damage. If you have experienced a direct injury to your hip or if you experience severe pain and a loss of mobility in the joint, it’s crucial that you see a hip specialist for a professional evaluation.

Schedule an appointment with Dr. Hamilton at Beacon Orthopaedics & Sports Medicine for a comprehensive evaluation of your hip. For your convenience, Dr. Hamilton meets with patients at Beacon East, Beacon West, or Summit Woods in Ohio or at Beacon’s Northern Kentucky location.