Feb. 16, 2024
This article takes a closer look at the growing field of hip preservation and the benefits it may offer to younger patients with hip pain and structural problems. Luke S. Spencer Gardner, M.D., a hip specialist in this area at Mayo Clinic's orthopedic practice in Florida, explains more.
What is hip preservation?
Hip preservation is a specialized area of orthopedic surgery where the surgeon repairs damaged structures in the patient's hip instead of replacing it. This process may involve repairing or reconstructing damaged tissue in or around the hip and often involves correcting structural bony abnormalities that caused the damage.
Why has hip preservation expanded in recent years?
Our understanding of the hip joint has grown exponentially over the past 30 to 40 years. Pioneers of hip preservation surgery identified abnormal anatomic and structural variants that were thought to cause hip pain in young patients and potentially lead to the early onset of osteoarthritis. Armed with this new understanding, surgeons began innovating and developing new ways to repair damage to the hip joint and address the underlying structural problems, often using minimally invasive techniques like hip arthroscopy. With these techniques, surgeons hope to delay or prevent the need for hip replacement surgery.
What is optimal timing for hip preservation?
Hip preservation surgery is only effective if employed before the onset of moderate to severe hip osteoarthritis.
Hip pain in a younger patient is usually an indicator that a structural issue exists in the hip joint or adjacent to it. At this point, an X-ray may still be read as normal. An MRI can be helpful if symptoms persist and often identifies damage to structures within the hip, such as the labrum. An MRI also can be useful to determine whether cartilage damage or early osteoarthritis is present.
Which patients are hip preservation candidates?
For patients with hip osteoarthritis, joint preservation options are no longer useful. However, if structural issues exist in a patient's hip without substantial cartilage wear, preservation techniques may be employed.
Joint preservation offers patients the following benefits:
- Often a minimally invasive procedure.
- Only 2 to 3 small incisions.
- Ability to preserve the native joint.
- Potentially faster recovery than hip replacement surgery.
- Reduced pain.
How do hip structural issues originate?
Some structural issues eligible for hip preservation surgery may have been present at birth, such as hip dysplasia. Though recognition of hip dysplasia early in a patient's life has improved, some young patients slip through.
In other cases, such as femoroacetabular impingement, these issues can develop over a patient's childhood and young adult life, based on that individual's activities. Participation in cutting and pivoting sports, such as hockey, football, soccer and basketball, during adolescence may lead to the development of structural changes like a cam deformity, which causes hip impingement, labral tearing, and early cartilage damage and wear.
What are hip preservation's goals?
Short-term goals include treating pain and improving function. Long-term goals include joint preservation for many years and prevention of long-term damage and arthritis, potentially delaying or preventing the need for hip replacement.
Is hip preservation worth it? Or is it just another stop on the way to a total hip replacement?
It's absolutely worth it. Hip preservation means intervening at a time earlier in life when the hip pain may be limiting the patient. The symptoms impact the patient's quality of life, and the patient does not want to be held back. If the underlying hip problems are corrected and the damage repaired, patients enjoy a more active life with less pain during their younger years.
Do patients typically need to exhaust other modalities before hip preservation surgery?
Yes, we start with more conservative options before discussing surgical treatment. We may try activity modification to keep the hip out of positions that induce symptoms. We also may try physical therapy, over-the-counter pain medications or injections. If these do not have the desired impact for the patient's hip, we move to hip preservation surgery.
What are hip preservation surgery's risks?
The level of risk depends on the nature of the surgery. Hip arthroscopy is a safe surgery with low risk. Larger, more-invasive surgeries such as osteotomies, where the bone is cut and then reoriented, carry more risks. With proper training, all these surgeries can be completed with low risk to the patient.
When do you suggest referring a patient for a hip preservation consult?
I'd suggest referral whenever a young patient is experiencing hip pain. If you're comfortable with diagnosing and managing nonoperative treatment, I'd encourage you to do so. If you aren't comfortable with it, my team and I are happy to see them sooner.
How is hip preservation different at Mayo Clinic than at another facility?
Mayo Clinic hip preservation surgeons have a true depth of knowledge in the subspecialty and perform a high volume of hip preservation surgeries. We've also built a whole team of physicians, physical therapists and other healthcare professionals specifically to perform hip preservation operations at a high level and enable healing after surgery with appropriate rehabilitation guidelines.
For more information
Refer a patient to Mayo Clinic.