Hip Preservation

Adam Sassoon, M.D.Dr. Adam Sassoon specializes hip preservation in the setting of congenital, developmental and acquired hip deformities in an attempt to prolong the lifespan of the hip and prevent progression of arthritic changes to the joint, which might lead to an early hip replacement if left untreated.

Our aim with hip preservation is to maintain the lining of the joint (cartilage) in a good condition, prevent arthritis, and delay hip replacement surgery.

Hip replacement is a common treatment for advanced arthritis of the hip. Injury, deformity, and other hip conditions can cause degradation of the articular cartilage and lead to arthritis. Early intervention to improve hip alignment and mechanics can reduce arthritic damage to your hip, relieve pain, and delay, or in some cases eliminate, the need for hip replacement surgery. You and your doctor will decide whether including hip preservation in your treatment plan is right for you based on your age, activity level, degree of articular cartilage damage, and other factors. Older patients with more extensive damage are more appropriate candidates for arthroplasty, whereas patients 45 years of age and younger may be better suited for hip preservation surgery.

Hip Preservation Treatments

Non-surgical treatment is always the first course of action when treating hip pain. Conservative treatments including rest, activity modification, physical therapy, and/or anti-inflammatory medications, are successful at reducing or eliminating hip pain and swelling for certain hip conditions. Injections of corticosteroids are also commonly used if physical therapy and anti-inflammatory medications are not sufficient.

Hip Arthroscopy

Arthroscopy is a minimally invasive surgical procedure used to treat a variety of hip conditions. Arthroscopy allows a surgeon to access the hip joint via several small incisions rather than a large incision during open surgery, and allows for faster recovery times for patients. Not all hip procedures are performed arthroscopically and each patient is different. Our surgeons will work with you to develop a treatment plan for you that delivers the best possible outcome.

Hip Arthroscopy may be recommended as treatment for the following conditions:

  • Hip impingement (femoroacetabular impingement)
  • Labral Tears
  • Removal of loose fragments of cartilage inside the hip joint

See an example of hip arthroscopy in the animation below.

If your deformity is amenable to arthroscopic treatment, you will be referred to one of our arthroscopic specialists.

Surgical Hip Dislocation

Surgical hip dislocation is an open surgical procedure used to treat larger deformities that arthroscopy is unable to adequately or safely address. The hip joint is deep and hard to access through the variety of muscles and tissues that surround and support it. Surgical hip dislocation allows surgeons wider access to the hip joint to perform certain procedures including labral repairs, femoral osteochondroplasty, and osteotomies. Surgical hip dislocation is used to treat the following hip conditions:

  • Labral tears (damage to the labrum, which acts like a cartilage cuff around the hip socket)
  • Surface cartilage (articular cartilage) damage
  • Femoroacetabular impingement deformities(Cam and Pincer Deformitites)
  • Femoral head fractures
  • Perthes Deformities
  • Dysplasia

Femoral and Periacetabular Osteotomy

Osteotomies are performed to correct abnormal alignment of the hip joint and hip dysplasia. Osteotomies are open surgical procedures that involve re-orienting either the femur or acetabulum (socket) of the hip joint to realign and relieve stress on the hip joint.

Hip Preservation Conditions

Labral Tears

The labrum of the hip is a ring of cartilage that surrounds the socket portion of the hip joint (the acetabulum) and provides cushioning and stability for the hip. Labral tears can occur through trauma or injury, structural abnormalities, wear from repetitive motion, or degeneration from osteoarthritis. Non-surgical treatment with anti-inflammatory medication, physical therapy, and rest is prescribed as initial conservative treatment for relief of pain. Pain from labral tears that is not responsive to conservative treatment may require surgery, arthroscopic or open, to remove or repair the torn labrum.

Hip Impingement

Hip impingement is caused by bony abnormalities of the hip joint that cause early contact between the ball of the joint and the socket. This leads to pain and can damage the labrum and articular cartilage, eventually leading to osteoarthritis. Non-surgical treatment options of anti-inflammatory medication, activity modification, rest, physical therapy, and corticosteroid injections may be used to relieve pain. However, these treatment options will not repair the underlying source of hip impingement pain and arthroscopic repair is required when pain is not manageable with non-surgical options.

Developmental Dysplasia of the Hip

Hip dysplasia occurs when the socket of the hip joint is too shallow or misshapen and does not fully support the ball of the hip joint. This leads to edge loading of the articular cartilage and early degeneration of the joint. Hip dysplasia is often identified in infancy or childhood but may not be diagnosed until adolescence or adulthood. Mild hip dysplasia can often be treated non-surgically with weight loss, activity modification, physical therapy, and corticosteroid injections to relieve pain and pressure on the affected hip. The abnormal shape of the dysplastic hip joint can cause accelerated degeneration of the labrum and articular cartilage and lead to early on-set osteoarthritis. More severe cases of hip dysplasia are treated via osteotomy. An osteotomy is a surgical procedure in which portions of bone are cut and repositioned to realign the hip and prevent abnormal wear of cartilage. Osteotomies are very successful in improving the longevity of the hip joint and relieving pain. Osteotomies are usually indicated for patients without extensive cartilage injury. Patients with extensive cartilage injury and arthritis of the hip may not be good candidates for osteotomies and may require a total hip replacement.

Osteonecrosis

Osteonecrosis occurs when portions of bone tissue die due to inadequate supply of blood, causing the bone to collapse. When osteonecrosis occurs in the hip, articular surfaces of the hip are destroyed leading to rapid progression of osteoarthritis. Treatment of osteonecrosis depends on the severity and location of damage. Non-surgical treatments may slow the progression of osteonecrosis but most patients with osteonecrosis eventually require surgery. Surgical treatment options may include bone grafts, osteotomy, core decompression, and in late stage cases with osteoarthritic damage, joint replacement.

Osteoarthritis

Osteoarthritis of the hip is the degeneration of the articular cartilage of the hip joint. Early stages of osteoarthritis can be treated non-surgically with anti-inflammatory medication, physical therapy, and activity modification. Hip preservation treatments vary but they all aim to preserve the natural hip joint and limit damage from osteoarthritis and delay or prevent eventual hip replacement surgery. Learn more about osteoarthritis of the hip.