Hip preservation: what to know

Hip preservation surgery is an alternative to stave off hip replacement surgery, which is preferable for younger patients. In this article, a consultant orthopaedic and trauma surgeon explains the conditions that indicate hip preservation, and the key differences between it and a hip replacement.

What are the hips and when do they need preservation surgery?

The hips are two major joints that connect the thigh bones, called femurs, to the pelvis in a ball-and-socket configuration. The top of the femur, called the femoral head, fits into a niche at the side of the pelvis, called the acetabulum. The bones are anchored together with muscles and tendons, and in the space between these bones are cartilage and a lubricant fluid called synovial fluid. This enables smooth movement and a wide range of motion.

However, the hips can become damaged or dysfunctional in ways that require surgical intervention. At times, hip replacement is necessary, but in some cases, hip preservation surgery, which involves the repair of damaged tissues or bones by resurfacing or reconstruction, may be recommended instead, particularly for patients younger than 60 years old with significant hip pain that is not due to osteoarthritis. Hip replacement prosthetics can last about 20 years, so to avoid repeatedly doing the replacement surgery and the lengthy recovery process, preservation is ideal to prevent further deterioration of the joint and prolong its life. Other conditions that are suitable to be treated with hip preservation surgery include:

• Femoro-acetabular impingement (FAI), which is when bone irregularities cause friction and pain, and is a common ailment for younger people.
• Hip dislocation, which is when the femoral head slips out of the acetabulum
• Hip dysplasia, which is when the acetabulum is too shallow and doesn’t adequately house the femoral head
• Labral tear, which is a tear or separation of cartilage that surrounds the joint
• Avascular necrosis, which is when there are obstructions to blood flow to the joint that can cause bone tissue death

To determine if a patient is suitable for a hip preservation procedure, doctors will have to consider their medical history, current condition, and the circumstances of their hip pain or dysfunction. Children and adults younger than 60 are ideal patients for this procedure. Doctors may conduct MRIs, CT scans, or X-rays to show the depth of damage to the bone and cartilage to assess the necessity of the procedure, and which technique they will employ.

What are the types of hip preservation surgery?

Whereas hip replacement surgery involves the removal of the femoral head, and prostheses being fit on the femur and into the acetabulum, hip preservation focuses more on using and reshaping existing structures to provide relief and mobility to the patient. There are several techniques of hip preservation, and which one is performed depends on the patient’s condition and the root of their hip issues. This includes:

• Femoral osteotomy, where the femur is cut and reshaped so that it can better fit into the acetabulum, distributing the weight more comfortably.
• Hip arthroscopy, which is a minimally invasive procedure using an arthroscope inserted through small incisions to investigate and repair damage.
• Periacetabular osteotomy, where the acetabulum is cut and removed from the rest of the pelvis and reattached with screws at a better angle. It is utilised in cases of hip dysplasia.
• Cartilage or tendon repairs, where tears and damages are mended by the surgeon. This may also include allografts, which are when tissue is donated from other individuals, or autografts, which are when tissue is donated from other sites in the patient’s body.
• Surgical hip dislocation, where the hip is purposely dislocated so the surgeons can easily access severe deformities or damage.

If you are experiencing hip pain, you can consult with a specialist on Top Doctors