Is Hip Preservation Surgery for You?
New Option for People Under Ages 15 to 55
Hip preservation surgery is a relatively new option for people ages 15 to 55. Occasionally, it may be an option for people who are younger or older. Hip preservation procedures may be beneficial for adults who:
- Were diagnosed with hip dysplasia as children or young adults and now have pain
- Have hip impingement
- Have AVN of the femoral head
- Put their hips through extreme ranges of motion during athletic activities
Best for Those Who Haven’t Developed Arthritis
People who have hip preservation treatments before arthritis develops have the best success. If you have moderate hip arthritis, you may benefit from a different hip surgery, such as hip replacement.
An Option After You’ve Tried Nonsurgical Treatments
Our comprehensive evaluation of your condition will help determine the best treatment approach for you. Your treatment may start with nonsurgical therapies such as:
- Activity modification
- Nonsteroidal anti-inflammatory medications
- Ultrasound-guided injections of numbing medication, with or without steroid medication
- Physical therapy
If these are unsuccessful, hip preservation surgery may be the next step. We work with you to help you understand your condition, manage your expectations, and achieve the best possible outcome.
Surgical Procedures for Hip Preservation
Hip Arthroscopy
During this minimally invasive procedure, surgical tools and a camera called an arthroscope are inserted through small incisions in the hip. Special equipment applies traction to your hip and safely separates the ball from the hip socket. The arthroscope allows the surgeon to see and repair tears of the labrum that may have resulted from hip impingement or hip dysplasia. It also allows for correction of the underlying structural problem that caused the tear.
Duke hip surgeons specialize in using postless distraction for hip arthroscopy. Traditionally during surgery, a foam post is placed between the patient’s legs to decrease pressure on the hip. This can result in temporary but painful problems including groin sensitivity. With postless distraction, the patient lies on a soft foam pad, which keeps them in place. No post is required, so there are fewer complications and increased patient comfort after surgery.
Surgical Dislocation
Surgeons safely dislocate the hip socket without compromising the blood supply. This procedure is used in select circumstances to repair the labrum and recontour the socket. It is particularly helpful in adults with complex deformities, which may not be fully treated with hip arthroscopy.
Periacetabular Osteotomy (PAO)
With PAO, your surgeon corrects hip dysplasia by cutting the bone around the hip socket free from the pelvis. This allows them to then reposition the hip socket to provide the needed structural coverage in your hip. When used to treat early-stage hip dysplasia, PAO has been shown to reduce hip pain and preserve hip function for decades.
Core Decompression with Free Vascularized Fibular Grafting (FVFG)
This specialized technique addresses AVN in the ball of the hip (the femoral head). In FVFG, the surgeon removes the dead bone before the ball breaks and inserts a section of bone and blood vessels taken from your fibula, the smaller of the two bones in your lower leg. This allows new, live bone to grow, leading to normal hip function. This procedure is appropriate for patients ages 35 and younger.
Core Decompression with Subchondral Graft
Occasionally, very small areas of AVN may not require FVFG. In these situations, core decompression with bone grafting just under the cartilage surface (subchondral) by other means can be done.
