If you have a painful hip condition such as hip dysplasia, hip impingement, or avascular necrosis 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.
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 is 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) is 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 result is wear of your hip joint.
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, so treating the labral tear alone makes it likely your hip pain will eventually return. Over time, untreated hip dysplasia or hip impingement can lead to arthritis and, eventually, hip replacement surgery.
Avascular necrosis (AVN) of the femoral head is 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, causing 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.
Duke orthopaedic clinics are located throughout the Triangle. In-person and virtual appointments are available.
Is Hip Preservation Surgery for You?
New Option for People Ages 20-50
Hip preservation surgery is a relatively new option for people ages 20 to 50. 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 and now have pain
- Have hip impingement
- Have avascular necrosis 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 guide which treatment approach we recommend. Your treatment may start with nonsurgical therapies such as:
- Activity modification
- Nonsteroidal anti-inflammatory medications
- Ultrasound-guided injections of numbing medication, with or without or 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.
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 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.
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.
Using ultrasound for guidance, the doctor injects a small amount of numbing medicine (similar to what a dentist would use) into your hip joint to help determine where your pain is coming from.
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 2020–2021.
Why Choose Duke
National Leaders in Hip Preservation
Each year, our hip preservation specialists perform hundreds of 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, 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 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.