Hip Preservation Surgery

Hip Preservation Surgery

Hip preservation surgery describes a group of procedures designed to protect, repair, and restore a patient's own hip joint rather than replace it. When the ball-and-socket hip is damaged by structural problems, cartilage or labral injuries, or abnormal bone shape, preserving the natural joint can help many patients stay active and may delay or reduce the likelihood of needing a hip replacement later in life. Because these techniques often address problems in younger, active patients, the goal is to correct the underlying mechanics of the joint while keeping as much healthy tissue as possible.

The hip specialists at Midwest Orthopaedics at Rush (MOR) evaluate each hip individually. Depending on what is causing the pain or instability, a treatment plan may involve arthroscopy, an osteotomy to reshape the socket, or a combination of techniques. Non-surgical care, including rest, activity modification, physical therapy, and injections, is typically considered before surgery is recommended.

In broad terms, hip preservation surgery aims to:

• Repair damaged structures, such as a torn labrum or injured cartilage, inside the joint
• Correct abnormal bone shape or coverage so the joint moves and loads more normally
• Relieve pain and improve function in ways that may help many patients stay active
• Keep as much of the patient's own healthy tissue as possible, which for appropriate candidates may delay or reduce the likelihood of a future hip replacement

When Hip Preservation Is an Option

Hip preservation may be considered when hip pain, catching, or instability does not improve with non-surgical treatment, and when imaging shows a structural problem that surgery can address. Preservation techniques are generally most appropriate before significant arthritis develops, because once the joint surface is badly worn, joint-preserving surgery is less likely to help and other options may be discussed.

A hip preservation evaluation may be appropriate for patients with:

• Hip dysplasia, in which the socket (acetabulum) is too shallow to fully cover and support the ball of the joint
• Femoroacetabular impingement (FAI), where extra bone on the ball or socket pinches the soft tissues during movement
• A hip labral tear, a tear in the ring of cartilage that lines and stabilizes the socket
• Cartilage injuries, loose bodies, or inflammation of the joint lining (synovitis)
• Persistent groin or front-of-hip pain in a younger, active patient without established arthritis

Whether hip preservation is the right approach depends on your age, activity level, the condition of the cartilage, and the specific shape of your hip. A surgeon reviews your imaging and examination findings with you to determine whether you are a candidate.

Hip Arthroscopy

Hip arthroscopy is a minimally invasive procedure that lets a surgeon see and treat the inside of the hip joint through small incisions rather than a large open incision. The surgeon inserts a thin camera, called an arthroscope, into the joint and views the structures on a monitor, then uses small instruments passed through separate incisions to make the repair. Because the incisions are small, many patients experience less soft-tissue disruption than with open surgery.

What Hip Arthroscopy Can Treat

Hip arthroscopy is used to address a range of problems inside and around the joint, including:

• Labral tears, including repair and in some cases reconstruction or augmentation of the labrum
• Femoroacetabular impingement, reshaping excess bone on the femoral head or acetabular rim so the joint moves without pinching
• Damaged or torn cartilage
• Inflamed joint lining (synovitis) and loose fragments of bone or cartilage within the joint

What to Expect

Hip arthroscopy is often performed as an outpatient procedure, meaning many patients go home the same day. It is commonly done under general anesthesia, and the leg may be placed in gentle traction so the surgeon can access the joint. The length of surgery depends on what is found and how much work is needed. Every surgical procedure carries risks, which for hip arthroscopy can include infection, blood clots, and temporary numbness related to positioning, and your surgeon reviews the specific risks and benefits with you before you decide to proceed.

Periacetabular Osteotomy (PAO) for Hip Dysplasia

Periacetabular osteotomy (PAO) is an open joint-preserving procedure used primarily to treat hip dysplasia, a condition in which the acetabulum is too shallow to properly cover the ball of the joint. When the socket does not provide enough coverage, the labrum and cartilage carry more load than they are designed to, which over time can lead to pain, labral tears, and arthritis.

During a PAO, the surgeon makes controlled cuts in the bone around the socket and repositions the acetabulum so it covers the femoral head more completely. The repositioned bone is then secured, usually with screws, while it heals. By improving how the joint is loaded, PAO aims to reduce pain and may help preserve the natural hip in appropriate candidates, often younger adults with dysplasia but without advanced arthritis. In some cases a femoral osteotomy, which reshapes the upper thighbone, is recommended instead of or in addition to a PAO, depending on the specific structural problem.

PAO is a larger procedure than arthroscopy and typically involves a hospital stay and a longer, protected recovery with restricted weight-bearing while the bone heals. As with any surgery, PAO carries risks, and your surgeon will discuss candidacy, expected recovery, and potential complications with you in detail.

Treating Labral Tears and Impingement Arthroscopically

Labral tears and femoroacetabular impingement frequently occur together, because abnormal bone shape can damage the labrum over time. When surgery is indicated, both are often addressed during the same arthroscopic procedure: the surgeon reshapes the impinging bone and repairs the torn labrum so the joint can move more smoothly. To understand the underlying conditions in more depth, see our pages on femoroacetabular impingement and hip labral tear.

Not every labral tear or impingement needs surgery. Many patients improve with physical therapy and activity modification, and surgery is generally considered when symptoms persist despite non-surgical care and imaging confirms a structural cause a procedure can correct.

Recovery

Recovery after hip preservation surgery depends heavily on the specific procedure and what was repaired. Because the range is wide, your surgeon and physical therapy team build a rehabilitation plan tailored to you.

• Hip arthroscopy: Many patients use crutches for a period of time and begin physical therapy to restore motion and strength. Depending on what was repaired, crutch use may last only until any limping resolves, or longer after a more extensive repair. Return to higher-impact activity is gradual and guided by your surgeon.
• PAO: Recovery is longer. Patients typically follow a period of protected or restricted weight-bearing while the bone heals, followed by a structured physical therapy progression over several months.

Physical therapy is an important part of recovery for most hip preservation procedures. Recovery timelines and outcomes vary from patient to patient, and your care team will set expectations based on your procedure, your hip, and your progress.

Why Choose MOR for Hip Preservation

Hip preservation is a focused area of orthopedic surgery, and the surgeons at MOR who perform these procedures are fellowship-trained in the techniques involved, from arthroscopic labral repair to periacetabular osteotomy. Care is coordinated across sports medicine surgeons, pediatric orthopedic surgeons, orthopedic trauma surgeons, rehabilitation specialists, and physical therapists, so patients are evaluated by clinicians experienced with the full range of joint-preserving options, and with hip replacement, if that becomes the more appropriate path.

If a hip is too damaged for preservation, MOR also offers hip replacement, including minimally invasive anterior-approach techniques.

Frequently Asked Questions

What is the difference between hip preservation and hip replacement?

Hip preservation repairs and reshapes your own hip joint to keep it functioning, while hip replacement removes the damaged joint surfaces and replaces them with an implant. Preservation is generally considered for younger, active patients before significant arthritis develops; replacement is more often appropriate when the joint is badly worn. A surgeon can help you understand which approach fits your situation.

Is hip arthroscopy an outpatient procedure?

For many patients, yes. Hip arthroscopy is frequently performed on an outpatient basis, meaning you go home the same day. Whether it is right for you, and whether it is done as an outpatient procedure, depends on your health and the specifics of your hip.

Who is a candidate for a periacetabular osteotomy (PAO)?

PAO is most often considered for younger adults with hip dysplasia, a shallow socket, who do not yet have advanced arthritis. Candidacy depends on the shape of your hip, the condition of the cartilage, your age, and your activity level. A surgeon determines whether PAO is appropriate after reviewing your imaging and examination.

Can hip preservation surgery prevent a hip replacement?

Hip preservation is intended to relieve symptoms and improve how the joint is loaded, which may help some patients delay or reduce the likelihood of needing a hip replacement. It cannot guarantee that a replacement will never be needed, because outcomes vary with the condition of the joint and other individual factors. Your surgeon can discuss what preservation may realistically offer in your case.

How long is recovery after hip preservation surgery?

It varies by procedure. Recovery after hip arthroscopy is generally shorter, while recovery after a PAO is longer and involves a period of protected weight-bearing. Your surgeon and physical therapist provide a rehabilitation plan and timeline specific to your procedure and progress.

This page is for general education and is not a substitute for professional medical advice, diagnosis, or treatment. Please consult a qualified physician about your specific condition.