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Hip Preservation Surgery

For Hip Dysplasia, Hip Impingement, or Avascular Necrosis

View Hip Dysplasia in Babies

If you have a painful hip condition such as hip dysplasia, hip impingement, or avascular necrosis (AVN) and haven’t developed significant arthritis, hip preservation surgery may be your best treatment option. In addition to alleviating your hip pain and restoring normal function, hip preservation surgery can reduce your risk of developing premature arthritis and the need for hip replacement surgery later on.

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Painful Hip Conditions

Hip Dysplasia and Hip Impingement
Your hip is a ball-and-socket joint. The ball at the top of your thigh bone, or femur, fits into a socket in your pelvis called the acetabulum. Hip dysplasia occurs when the socket doesn’t adequately cover the ball. This may be because the socket is too small or shallow, isn’t positioned correctly, or both.

Hip impingement (also called femoroacetabular impingement, or FAI) occurs when normal movement results in abnormal contact between the ball and socket of your hip joint. Typically, this happens when the socket, ball, or both have an irregular shape. The resulting shape mismatch between the ball and socket causes wear of your hip joint.

Labral Tears
In both hip dysplasia and hip impingement, some of the earliest symptoms are caused by irritation or tearing of the hip labrum, a type of cartilage that lines the rim of the hip socket. A hip labrum tear is nearly always the result of an underlying condition. It is important that the treatment of your torn labrum also includes identifying and treating the underlying condition to fully restore function and minimize the risk of the injury recurring. Over time, untreated hip dysplasia or hip impingement can lead to arthritis and, eventually, hip replacement surgery.

Avascular Necrosis
AVN of the femoral head happens when part of the ball at the top of your thigh bone loses blood supply, causing that segment of bone to die. Your body tries to heal the area by replacing the dead bone with new, live bone. Unfortunately, the new bone is weaker than normal bone, resulting in pain when you put weight on it. Eventually, the weak area collapses, and the ball no longer fits well in the socket. Over time, this irregular bone wears away the cartilage in your hip joint, causing arthritis.

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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.

Our Locations

Duke orthopaedic clinics are throughout the Triangle. In-person and virtual appointments are available.

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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.

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Tests

X-Ray and CT

Imaging tests are used to identify complex problems in the hip joint.

3-Tesla MRI Scans

We use 3-Tesla MRI, the strongest MRI magnet available, to create a 3D, high-resolution reconstruction of the hip to identify labral tears and diagnose your pain. This new imaging advance does not require a hip injection or CT scans, reducing your exposure to radiation.

MRI Arthrograms (MRA)

Sometimes dye will be injected into the hip joint to enhance traditional MRI images. Our orthopaedic surgeons and radiologists worked together to develop a specialized sequence of magnetic resonance arthrogram images to diagnose hip dysplasia.

Diagnostic Injection

Using ultrasound for guidance, your doctor injects a small amount of numbing medicine (similar to what a dentist would use) into your hip joint to help determine the source of your pain.

Best Orthopaedic Hospital in North Carolina

Where you receive your care matters. Duke University Hospital is proud of our team and the exceptional care they provide. They are why our orthopaedics program is nationally ranked and the highest-ranked program in North Carolina, according to U.S. News & World Report for 2025–2026.

Why Choose Duke

National Leaders in Hip Preservation
Each year, our hip preservation specialists perform over 500 hip preservation surgeries. Our skill and experience mean you recover faster and have less pain.

A Team of Experts
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, and occupational therapists who all devote themselves to your well-being. You’ll be treated compassionately and holistically, with the goal of improving your function and enhancing your quality of life.

Ongoing Research Offers New Advances
Our hip preservation specialists are researching better ways to diagnose conditions that may benefit from hip preservation techniques, as well as how to optimize pain control following surgery.

This page was medically reviewed on 01/28/2022 by

Brian D. Lewis, MD | Hip Arthroscopist