Hip preservation surgery
Hip dysplasia and hip impingement
Duke hip preservation surgeons perform hundreds of hip preservation surgeries annually to reduce hip pain and restore normal hip function. When painful hip conditions such as hip dysplasia and hip impingement are diagnosed early, we are among the few orthopaedic specialists in the country to use complex hip preservation techniques to help you reduce your risk for premature arthritis and hip replacement surgery in your later years.
Hip preservation may be best option for hip pain
Activity-related hip pain should not be ignored, especially if you experience it when walking or moving. Feeling a sharp, intense, groin pain when pivoting unexpectedly can be a red flag to see an orthopaedic specialist as it may signal a tear in the labrum, the lining of the cartilage around the hip socket. A labral tear may be caused by a deteriorating hip condition such as hip dysplasia or hip impingement (doctors call it FemoroAcetabular Impingement or FAI). Left untreated, either condition can lead to arthritis and eventually, hip replacement surgery. If hip dysplasia or hip impingement is identified as the cause of your pain, hip preservation may be your best option.
Hip preservation surgery is not for everyone, but it is a relatively new option for people age 20 to 50 in general, (Occasionally it may be an option for people who are younger or older.) Hip preservation procedures may be beneficial for athletes who put their hips through extreme ranges of motion, and people who were diagnosed with hip dysplasia as a child and are now experiencing pain as an adult. Hip preservation surgery may also be an option for people who experience avascular necrosis, a disease that results from temporary or permanent loss of blood supply to the bone. It is typically not an option if moderate arthritis is already present.
Choose Duke Orthopaedics for your hip preservation procedure because we offer:
- National leaders in hip preservation. Our orthopaedic program is consistently ranked as one of the top in the country by U.S. News & World Report. Our hip preservations specialists perform hundreds of hip preservations surgeries each year, and are among the few surgeons in the country to perform complicated hip surgeries such as periacetabular osteotomy (PAO) for hip dysplasia. Our vast experience means you recover faster and experience less pain.
- The right treatment for you. Selecting the right candidate for hip preservation techniques is important. Our comprehensive evaluation of your condition will guide our recommendations. Your treatment may start with non-operative therapies such as activity modification, non-steroidal anti-inflammatories, injections and physical therapy. If those are unsuccessful, hip preservation surgery may be the next step. If you have moderate hip arthritis, you may benefit from a different hip surgery, such as hip replacement. We help you understand your condition, manage your expectations, and work with you to achieve the best possible outcome.
- Advanced imaging techniques. We are among the few centers in the country to offer 3-T MRI, a powerful diagnostic tool that requires no painful injections into the hip joint, and no CT scans. This reduces anxiety often associated with traditional imaging tests, and requires less radiation exposure.
- Game-changing techniques. Our doctors pioneered game-changing techniques to relieve hip pain and dysfunction caused by labral tears that result from hip impingement (FAI), and hip dysplasia. We’re nationally recognized for our comprehensive treatment approach to avascular necrosis, as well as conditions typically seen in children and adolescents, including slipped capital femoral epiphysis. (This occurs when the upper part of the thighbone shifts and weakens the hip joint).
- Expert teamwork. You’ll work with fellowship-trained orthopaedic surgeons and doctors who have undergone years of specialized training. Your team will also include physician assistants, nurses, anesthesiologists, physical therapists, occupational therapists, and patient resource managers who all devote themselves to your well being. You’ll be treated compassionately and holistically, with the goal of returning to your optimal function and enhanced quality of life.
- Ongoing research. Our hip preservation specialists are researching ways to improve how patients are diagnosed with hip conditions that may benefit from hip preservation techniques, as well as how to optimize pain control following surgery.
We offer a full array of conservative treatments for hip pain, such as activity modification, medication, steroid and pain-relief injections, and specialized physical therapy. If they aren’t successful, we offer these hip preservation surgical options.
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 visualize the tear of the labrum – the cartilage that lines the rim of the socket – and perform the repair which may be result from impingement or dysplasia.
Corrects hip dysplasia by cutting the bone to free the hip socket from the pelvis and repositioning the socket to change its orientation. Hip dysplasia is a structural condition in which the relationship between the ball and socket of the hip joint is out of balance. PAO rebalances this relationship. When used to treat early-stage hip dysplasia, PAO has been shown to reduce hip pain and preserve hip function for many years.
Surgeons safely disclose the hip socket without compromising the blood supply. This procedure is used in select circumstances to repair the labrum and re-contour the socket. It is particularly helpful in adult patients with complex deformities. It is also used in children with slipped capital femoral epiphysis (commonly referred to as a SCFE).
A specialized technique that addresses avascular necrosis of the femoral head or AVN, a disease in which the bone in the ball of the hip (the femoral head) dies and is slowly replaced as the body removes dead bone and lays down living bone. During this process, the hip bone weakens and eventually can break or fracture through the surface of the ball. This can cause hip pain. FVFG removes the dead bone before the ball breaks, and allows new live bone to heal. This leads to normal hip function.
In addition to standard X-rays, MRI and CT scans are used to identify complex problems in the hip joint.
We use 3-Tesla MRI, the strongest MRI magnet available, to create a 3-D, high resolution reconstruction of the hip to identify labral tears, and diagnose your pain. This new imaging advance requires no hip injection and no CT scans, which reduces your exposure to radiation.
Sometimes an injection of dye will be placed in the hip joint to enhance traditional MRI images. Our orthopaedic surgeons and radiologists have collaborated to develop a specialized sequence of magnetic resonance arthrogram images that are used to diagnose hip dysplasia.
Numbing medication is injected directly into the hip under ultrasound guidance to diagnose the origin of hip pain.