Hip joint preservation vs. replacement surgery: what are the pros and cons?

Suffering from chronic pain in your hip can prevent you from doing activities that you enjoy and adds an extra strain on your day-to-day life. Hip joint preservation and replacement surgery are two very different procedures that can both be used to treat hip pain; however, deciding which one is right for you can be complicated and depends on a variety of factors.

We spoke to Mr Adam Cohen, a renowned consultant orthopaedic and trauma surgeon, to explain a little bit more about these two procedures, when they might be offered and the pros and cons of each approach.

What are the most common causes of hip joint pain?

The commonest cause of hip pain in adults is osteoarthritis. However, this may not always be the case and the cause in that situation is usually age dependant and where the pain is located.

• Pain at the front of the hip — If pain is felt in the front of the hip, around the groin area, this may be due to a problem of the joint itself
• Pain on the outer border of the thigh — If pain is felt in this area, it could be due to trochanteric bursitis, which is quite a common condition
• Pain felt in the buttock — This could be due to the muscles or tendons at the back which control the hip or from a referred pain from the spine. Tendon inflammations are a commonly encountered problem if the joint itself is not to blame

In addition, younger adults may have pain as a result of a childhood deformity of the joint, which can lead to damage of the cartilage structures in the joint. An example of this would be a labral tear.

What happens during hip preservation surgery?

There is more than one type of surgical procedure involved in hip preservation. A specialist will decide on the type of operation the patient needs based on the cause of their hip pain. For example, if the patient has a labral tear as a result of a misshapen femoral head or socket, then hip arthroscopy may be the approbate operation to try to repair the labral tear and alter the bone deformity.

Hip arthroscopy involves a general anaesthetic and putting the legs in traction to open up a potential space between the head and the socket. This is so instruments can be inserted to perform the necessary procedure. If a patient has had a dysplasia (shallow socket) problem of the hip, then it is sometimes appropriate to change the orientation of the whole socket which involves cutting the bone all the way around the socket in order to move it. This is a big operation and can take quite some time to recover from.

The point of these types of surgery is to ‘preserve’ the original hip joint. The alternative to preservation surgery is to replace the joint.

What happens during hip replacement surgery?

A hip replacement is usually performed if the hip has ultimately become arthritic. During a hip replacement, the patient often has a spinal type of anaesthetic and the procedure can be performed through either an anterior or posterior approach. Regardless of the approach, the ball part of the joint is removed, the socket is re-lined with an implant and a metal ‘stem’ is inserted into the thigh bone which then has an artificial head implanted onto it. As the joint surfaces have been removed, the source of the pain goes.

What are the pros and cons of joint preservation surgery?

The main advantage of hip preservation surgery is that the patient keeps their original joint which has certain benefits. Often disorders of the hip joint which affect younger patients eventually go on to develop arthritis which subsequently requires replacement. In a way, preservation surgery is a method of delaying the need for joint replacement surgery.

It is, however, technically complex surgery and there are risks. As with all types of surgery, there is a risk of infection, nerve or blood vessel damage. Swelling and stiffness are common and sometimes the procedure does not help or cannot address the severity of the problem.

What are the pros and cons of hip replacement surgery?

The main advantage of hip replacement surgery is that in the majority of patients it effectively takes away the pain caused by hip arthritis. This usually allows arthritis sufferers to walk much better. The range of movement in the joint may be improved but not always.

The potential risks of hip replacement surgery are infection, thrombosis, nerve damage, blood vessel damage, dislocation, fracture and leg length discrepancy. In the long term, hip replacements can fail as a result of loosening which might require a revision operation.

How does a consultant decide which procedure is more suitable for their patient?

The decision as to which of the operations is appropriate is based on what is causing the pain and dysfunction of the hip joint i.e. the diagnosis. Age is often a factor when it comes to hip preservation surgery since there is very little to be gained in performing a joint saving operation if an older patient is showing signs of arthritis. Similarly, most specialists would be extremely cautious at offering a hip replacement to a younger adult as hip replacements are known to last for a limited period of time. This could potentially result in multiple hip replacement operations having to be performed if performed on a young patient.

If you are suffering from hip pain and interested in one of these procedures, visit Mr Adam Cohen’s Top Doctors profile and book a consultation with him.