Hip Preservation

The hip is a critical joint providing mobility, stability and function. The hip joint is a ball and socket joint at the connection between the pelvis and femur (thigh bone). The hip is carefully in balance with the other surrounding structures in the pelvis and lower spine. However, when this balance is distorted, the hip can begin to wear and tear, causing hip pain and discomfort. The field of hip preservation is dedicated to diagnosing and treating hip conditions that have led to hip pain and potential hip degeneration in adults and adolescents.

There are several potential conditions that can lead to hip degeneration and pain. These include atypical anatomy in and around the hip joint, which can be congenital, developmental or traumatic in origin. Strains and sprains of the muscles and ligaments around the hip may also cause hip joint pain. A short list of potential hip conditions includes:

• Hip Dysplasia
• Hip Impingement
• Hip Torsion/Rotation Abnormalities
• Labrum Tear
• Snapping Hip
• Hip Synovitis

The primary symptom in hip joint disorders is pain. Most often, this pain is primarily in the front of the hip, though it can be on the side or back of the hip. The pain is typically worse with activities and certain hip positions that exacerbate the underlying hip irritation. Pain symptoms often begin in adolescence or young adulthood, though can happen at any age.

The diagnosis of any hip condition begins with the patient telling the healthcare provider the history of the hip pain/symptoms followed by a physical examination performed by the healthcare provider. Imaging is often required as part of the diagnostic evaluation as many different hip conditions can present in a very similar manner. The first imaging obtained will be x-rays. If surgical treatment is recommended, advanced imaging such as computerized tomography (CT) and magnetic resonance imaging (MRI) will likely be obtained for enhanced three-dimensional understanding of the hip joint and surrounding tissues.

If you have hip pain that does not go away, please schedule an evaluation with your primary care provider or an orthopaedic specialist.

The management of hip pain typically begins with non-operative treatments. These include use of physical therapy and medicines such as anti-inflammatories. Often hip pain will resolve with these approaches. If hip pain remains unresolved, your physician may recommend an intra-articular injection of medication, which can be used both for pain relief and to provide further diagnostic information.

If the hip pain continues despite these measures, surgical treatment may be recommended. Several surgical options are available. The specific technique recommended will depend upon the underlying hip condition being treated. Potential surgical techniques include the Ganz periacetabular osteotomy (PAO), hip arthroscopy and surgical hip dislocation.

The Ganz PAO is a technique that allows the surgeon to re-orient the hip joint to provide a more appropriate relationship between the two sides of the hip joint. It is most often used to treat hip dysplasia, though it may be recommended for other hip conditions, such as certain types of hip impingement.

Hip arthroscopy is a minimally invasive surgical technique that allows the surgeon access to the hip joint through small incisions. These small incisions are used to insert a camera and multiple instruments into the hip joint, allowing the surgeon to address the underlying hip condition. This technique is most often used in the treatment of hip impingement.

The surgical hip dislocation is a technique that allows the surgeon to see the entire hip joint. It is most often used in the treatment of certain types of hip impingement. 

The specific prognosis for the hip depends largely on what hip condition is causing symptoms, how severe the condition is and how long the process has been present. Often, if the condition is treated early and minimal hip degeneration is present, the outlook can be excellent.