Hip Preservation

Through a unique collaboration with McGovern Medical School at UTHealth, affiliated orthopedic surgeons and the Memorial Hermann sports medicine team provides adolescents and young adults with a full range of surgical and nonsurgical treatments to restore and preserve patients’ natural hip function.

The multidisciplinary team of surgeons, musculoskeletal imaging experts, specialized hip physical therapists and other health care providers work collaboratively to accurately diagnose and tailor a treatment regimen to treat both the symptoms and the underlying causes of hip pain. The goal of treatment is to maximize the patient’s natural hip function using the most effective, least invasive option. Often, a patient can be treated with nonoperative techniques, such as activity modification, injections or physical therapy. If surgery is required, the team has the ability to perform the full spectrum of hip preservation surgeries, from minimally-invasive hip arthroscopy to complex hip osteotomies.

What is Hip Preservation Surgery?

The hip is a ball-and-socket joint comprised of the femur (thigh bone) and the pelvic bone. The head of the femur (ball) articulates with a cavity (socket) called the acetabulum in the pelvic bone. To facilitate smooth and near frictionless movement of the hip joint, the articulating surfaces of the femur head and acetabulum are covered by spongy articular cartilage. Injury, wear-and-tear and certain diseases can result in the wearing away of the cartilage tissue, causing painful rubbing of bones.

Hip replacement surgeries, in which damaged parts of the hip joint are removed and replaced with a prosthesis, have long been the choice of treatment. In patients, however, the prostheses are highly prone to wear-and-tear, necessitating repeat surgeries. By contrast, hip preservation is a surgery that overcomes the limitations of joint replacement by repairing or revising the patient’s own natural hip., in which damaged parts of the hip joint are removed and replaced with a prosthesis, have long been the choice of treatment. In patients, however, the prostheses are highly prone to wear-and-tear, necessitating repeat surgeries. By contrast, hip preservation is a surgery that overcomes the limitations of joint replacement by repairing or revising the patient’s own natural hip., in which damaged parts of the hip joint are removed and replaced with a prosthesis, have long been the choice of treatment. In patients, however, the prostheses are highly prone to wear-and-tear, necessitating repeat surgeries. By contrast, hip preservation is a surgery that overcomes the limitations of joint replacement by repairing or revising the patient’s own natural hip., in which damaged parts of the hip joint are removed and replaced with a prosthesis, have long been the choice of treatment. In patients, however, the prostheses are highly prone to wear-and-tear, necessitating repeat surgeries. By contrast, hip preservation is a surgery that overcomes the limitations of joint replacement by repairing or revising the patient’s own natural hip.

Conditions Treated

Some of the conditions indicated for hip preservation surgery include:

• Femoroacetabular impingement (FAI) – Friction in the hip joint from abnormal bony irregularities
• Hip dislocation – Head of the femur moves out of the socket
• Hip dysplasia – Congenital hip condition characterized by a shallow acetabulum or deformed femur
• Labral tear – Tear or separation of the labrum, a cartilaginous ring that surrounds the hip socket and seals the hip joint
• Avascular necrosis – Disrupted blood flow to the hip joint, causing death of bone tissue

Hip preservation surgery employs various techniques:

• Periacetabular osteotomy (PAO) – Surgical procedure to treat hip dysplasia that involves cutting the acetabulum from the pelvic bone and repositioning it with screws to allow for a better coverage of the femoral head. The procedure reduces pain, restores function and prevents further deterioration of the hip joint, thereby, increasing the life of the hip joint and postponing total hip replacement.
• Surgical hip dislocation – Surgical technique that involves the dislocation of the hip joint during surgery to facilitate complete access to the inside tissues of the hip joint, helping the surgeon to clearly view and treat a large variety of abnormalities present deep into the hip joint
• Femoral osteotomy – Surgical procedure in which the femur is cut at the end close to the hip joint and realigned so that it forms a normal angle, improving the distribution of force placed on the joint and preventing wear-and-tear of the cartilage
• Hip arthroscopy – Minimally-invasive surgical procedure in which a surgeon inserts an arthroscope through very small incisions into the hip joint to visualize, diagnose, and treat problems inside the hip joint

The various hip preservation surgeries for severe hip pain and dysfunction in young and active patients have been found to be beneficial, and help avoid or delay the need for hip replacement surgery. Determining the best approach is individualized to each patient based on careful review of imaging, specific and thorough examination and previous medical history.

After arthroscopic surgery, many patients go home the same day and can generally return to normal activity after about four months. The typical hospital stay for osteotomy patients is two to three days, with about six months before they return to normal activity. Patients who have undergone any of these procedures usually walk on crutches for about two months and undergo about six months of specialized rehabilitation, including physical therapy. Patients generally require follow-up X-rays at one- to five-year intervals. Long-term care also includes careful attention to potential development of arthritis.

Hip preservation treatment is available at Memorial Hermann-Texas Medical Center and Memorial Hermann Memorial City Medical Center. Schedule an appointment online or by calling (713) 222-2273