Hip replacements change life for the better. More than half a million of these surgeries are performed each year in the United States, and patients tend to report improvements in pain and quality of life.
However, if you’re young or middle-aged, you might need more than one replacement. To avoid that, your doctor may consider hip preservation first.
“The goal of hip preservation is to preserve the original hip for young people with hip pain,” says UNC Health orthopedic surgeon Samantha Tayne, MD. “With a hip replacement, there are plastic and metal parts that wear out over time and need to be replaced. If we prevent or delay hip replacement, young patients may not need multiple replacements and can still get back to their desired level of activity.”
Dr. Tayne answers common questions about hip preservation.
Who is a good candidate for hip preservation?
Hip preservation may be a good fit for people who had a structural issue with their hip at birth or one that was acquired, such as hip dysplasia or hip impingement (more formally known as femoroacetabular impingement).
Hip impingement and other hip deformities also can develop in the child and teen years if you play sports that require a lot of twisting, pivoting or squatting; these sports also can cause labral tears, when the cartilage that protects the hip is injured.
Just having these deformities or injuries doesn’t mean you need hip preservation.
“A lot of people will get imaging that shows they have mild dysplasia, impingement or a labral tear, but not everyone is symptomatic,” Dr. Tayne says. “If you’re not having pain, there’s no data to support doing hip preservation as prevention for future issues.”
But if you are having pain in your hip, it’s important to get checked out; untreated pain in the hip puts you at higher risk for osteoarthritis in that joint.
“Before these hip preservation options were developed, people may have been told there’s nothing to be done other than a hip replacement, so just deal with it,” Dr. Tayne says. “If you’re having pain or limiting your activity due to hip pain, don’t try to survive the pain for 10 years and then come in. It’s ideal to come in sooner rather than later.”
That’s because hip preservation works best for people younger than 50 years old who are not yet experiencing significant arthritis or cartilage changes, though Dr. Tayne notes that exceptions can be made depending on the overall situation and health of the patient.
What does hip preservation involve?
Hip preservation involves a combination of nonsurgical and surgical options.
“Everyone should start with conservative management—physical therapy, steroid injections—before surgery,” Dr. Tayne says. “We also want to ensure that the hip is the cause of your pain before any operation. Pain in that area could be related to back pain or pelvic pain because the hip is a deep joint.”
These nonsurgical options may be enough to resolve pain so that you can do the activities you want to do, including running or exercising, playing sports or moving through your day without pain.
If they’re not sufficient, your doctor will consider surgical options. Some of these surgeries are more minimally invasive than total hip replacements while others are open surgeries, but they all have the benefit of not requiring a replacement of worn-out parts in a few decades.
For impingement or labral tears, you might be a candidate for a hip arthroscopy, where your surgeon makes three or four small incisions around your hip to make repairs to your cartilage or connective tissues to relieve pain.
“It’s less invasive, but it still requires rehab,” Dr. Tayne says. “The rehab and limitations can actually be a little bit more than with a hip replacement initially, because we’re trying to get your existing anatomy to heal.”
For some, the results are quickly noticeable.
“We often hear at a patient’s first follow-up appointment that the pain they experienced before is gone,” Dr. Tayne says. “They might still have some post-surgical pain, but they can tell that’s different from the pain they experienced pre-op. For some, it takes four to six months to see the benefits.”
Other surgeries include a periacetabular osteotomy, an open surgery where your doctor repositions or reshapes the hip socket so that the ball of the hip joint is better covered by the socket, and a femoral osteotomy, where the top of the femur, or thigh bone, is reshaped to better fit in the hip.
You might have one or all of these procedures, depending on the shape of your hip.
“With those open surgeries, it will take longer to feel the benefits, because the bone has to heal,” Dr. Tayne says. “It’s more likely to take four to six months to return to activity and feel the difference.”
It’s possible that a hip preservation procedure may be all that’s needed for the rest of your life; for some, hip replacement will be needed at a later date, but now you’re less likely to need a second replacement.
There may be even more options for hip preservation in the coming years.
“It’s a field that’s constantly evolving, and there may be more opportunities for hip preservation as options and techniques continue to improve,” Dr. Tayne says.
If you have pain in your hip, talk to your doctor. If you need a doctor, find one near you.