Hip Preservation Program

Abnormalities involving the hip joint can cause substantial disability and pain and can lead to early arthritis if left untreated. There are a number of underlying conditions that may cause abnormalities of the hip joint, including developmental dysplasia, Legg-Calve-Perthes disease, slipped capital femoral epiphysis, femoroacetabular impingement, avascular necrosis, congenital deformities of the hip and post-traumatic deformities of the hip. Regardless of cause, early intervention may minimize pain and disability while protecting the hip from further damage. Advanced surgical techniques are now available to correct improper hip mechanics before degenerative disease sets in and causes permanent damage to the hip joint. 

Adolescent and young adult hip dysplasia is a condition in which the hip joint did not develop properly during early childhood. It can result in a shallow and abnormal hip socket. In these instances, forces that are normally distributed across a large joint surface are instead focused across a much smaller area. This, in turn, leads to abnormal demands on the joint’s cartilage and to excessive stretching or loading of its soft tissues. Left untreated, a dysplastic hip can develop early wear and tear or arthritis. In many cases, the joint can slowly slip out of position. In severe instances, the joint can entirely dislocate or fall out of its socket.

A periacetabular osteotomy is a surgical procedure designed to rotate and reposition the hip socket. The goal of this procedure is to improve the coverage of the femoral head and increase the joint’s surface area, thereby minimizing pain and the development of premature arthritis. The surgery usually takes three to four hours and involves making four cuts in the pelvic bone around the hip joint to loosen the socket. Once loosened, the hip socket can be rotated and repositioned into a more normal anatomic position over the femoral head. During surgery, X-rays are used to help direct the bone cuts and ensure correct positioning. Several small screws are employed to hold the bone in place until it heals.

Surgery requires a short stay in the hospital. Patients are generally required to protect the hip during the months following surgery, allowing time for the bone to unite or heal. This generally requires the temporary use of crutches. Physical therapy is commonly prescribed once the bone has healed. Specific recommendations and instructions are offered based on patient-specific conditions and needs.

The hip is a ball-and-socket joint composed of the femoral head and the acetabulum, respectively. In some cases, such as congenital and acquired hip deformities, it is not sufficient to realign or reposition the acetabulum alone, and a femoral osteotomy may be recommended to reposition the ball, as well. Together with an acetabular or pelvic osteotomy, a femoral osteotomy can help change hip mechanics, allow hip forces to be transmitted on a healthier region, and improve the position of the femoral head within the acetabulum.

A femoral osteotomy is a procedure designed to realign the upper part of the femur. After making an incision, the bone is cut in the proper location using X-ray guidance. It is then redirected into an improved position and held in place using a specialized plate and screws. Once the bone has healed, these implants are sometimes removed through a separate surgery.

Surgery requires a short stay in the hospital. Patients are generally required to protect the hip during the months following surgery, allowing time for the bone to unite or heal. This generally requires the temporary use of crutches. Physical therapy is commonly prescribed once the bone has healed. Specific recommendations and instructions are offered based on patient-specific conditions and needs.

Hip pain can develop from a number of causes that involve abnormalities of the bone, the articular cartilage or other tissues, such as the labrum. These abnormalities can develop over time or result from a specific injury. Following careful examination and diagnostic imaging, some of these conditions require surgical intervention to treat pain, improve hip mechanics and avoid progressive damage to the hip joint and its various structures.

Hip arthroscopy is a minimally invasive surgical technique designed to visualize and treat damaged or abnormal structures within the hip joint. It is performed by making a small incision near the hip joint through which an arthroscope (a specialized miniature camera) can be inserted. Additional small incisions allow other specialized instruments to be introduced as well. This technique can be employed to treat labral injuries, either by debriding them and/or repairing them back to their anatomic location. It can also be used to reshape the femoral head and neck by removing bone deformities in cases of femoroacetabular impingement (FAI).

Surgery is generally an outpatient procedure, and patients can return home the same day. Patients may be required to protect the hip following surgery, allowing time for the bone and soft tissues to heal. This generally requires the temporary use of crutches. Physical therapy is commonly prescribed. Specific recommendations and instructions are offered based on patient-specific conditions and needs.

The hip is a ball-and-socket joint composed of the femoral head and the acetabulum, respectively. In some hip conditions, treatment requires unimpeded surgical access to adequately visualize the anatomy and properly address the underlying issue. These instances include some cases of femoroacetabular impingement, select tumors, intra-articular fractures of the femoral head, select pelvic fractures and select instances of developmental dysplasia of the hip. In such cases, a conventional open approach, rather than a minimally invasive one, may prove more appropriate.

A surgical hip dislocation is a procedure designed to carefully remove or dislocate the femoral head from within the acetabulum. This is performed in a controlled and deliberate manner, sparing the surrounding muscles and preserving the essential blood supply to the hip joint. A conventional incision is made near the hip, and the overlying soft tissues are dissected. A small bone osteotomy is performed, and the hip capsule is incised, exposing the hip joint. This technique affords a 360-degree view of the affected area and allows correction of deformities or abnormalities on both the femoral and acetabular sides of the joint. Once surgery is complete, the bone and soft tissues are repaired.

Surgery requires a short stay in the hospital. Patients are generally required to protect the hip during the months following surgery, allowing time for the bone and soft tissues to heal. This usually requires the temporary use of crutches. Physical therapy is commonly prescribed once the bone has healed. Specific recommendations and instructions are offered based on patient-specific conditions and needs.

The hip is a ball-and-socket joint composed of the femoral head and the acetabulum, respectively. Avascular necrosis (osteonecrosis) is a process that arises from a poor or disrupted blood supply within the hip joint that frequently affects the femoral head. This compromised blood supply leads to ischemic or dead bone in the region just below the femoral head’s surface. Without adequate support from healthy bone, the femoral head can collapse, resulting in hip pain, limited hip motion and eventually advanced arthritis of the hip.

Core decompression is a procedure designed to save or preserve the patient’s femoral head by encouraging new bone growth in the region of ischemic or unhealthy bone. It is performed by creating one larger hole or several smaller holes in the femoral head. This relieves pressure within the bone and creates channels for new blood vessels that can nourish and heal the affected region.

When osteonecrosis of the hip is diagnosed early, core decompression is often successful in preventing collapse, improving pain and restoring blood supply and healthy bone to the region. Core decompression is often combined with bone grafting to help the regeneration process. Frequently, this graft is taken from the patient’s bone marrow at the time of the procedure and injected into the femoral head following the decompression.

Surgery is generally an outpatient procedure, and patients can return home the same day. Patients may be required to protect the hip following surgery, allowing time for the bone and soft tissues to heal. This generally requires the temporary use of crutches. Physical therapy is commonly prescribed. Specific recommendations and instructions are offered based on patient-specific conditions and needs.