Hip Preservation Surgery
The hip is a ball and socket joint comprising of the femur (thigh bone) and the pelvic bone. The head of the femur (ball) articulates with a cavity (socket) called the acetabulum in the pelvic bone. To facilitate smooth and frictionless movement of the hip joint, the articulating surfaces of the femur head and acetabulum are covered by spongy articular cartilage. Injury, wear-and-tear and certain diseases can result in the wearing away of the cartilage tissue, causing painful rubbing of bones. Hip replacement surgeries have long been the choice of treatment, where the damaged parts of the joint are removed and replaced with a prosthesis. However, in young active patients, the prostheses are highly prone to wear-and-tear, and the need for repeat surgery. Hip preservation is a surgery that overcomes the limitations of joint replacement.
Some of the conditions indicated for hip preservation surgery include:
- Femoroacetabular impingement (FAI): friction in the hip joint from abnormal bony irregularities
- Hip dislocation: head of the femur moves out of the socket
- Hip dysplasia: congenital hip condition characterized by a shallow acetabulum
- Labral tear: tear or separation of the labrum, a cartilaginous ring that surrounds the socket and seals the hip joint
- Avascular necrosis: disrupted blood flow to the hip joint, causing death of bone tissue
Hip preservation surgery includes various techniques:
- Periacetabular osteotomy: Periacetabular osteotomy is a surgical procedure to treat hip dysplasia. This involves cutting the acetabulum from the pelvic bone and repositioning it with screws to allow for a better fit of the femoral head. The procedure reduces pain, restores function and prevents further deterioration of the hip joint, thereby increasing the life of the hip joint and postponing total hip replacement.
- Surgical hip dislocation: Surgical hip dislocation is a surgical technique that involves the dislocation of the hip joint during surgery to facilitate easy access to the inside tissues of the hip joint. It helps your surgeon to clearly view and treat abnormalities present deep into the hip joint.
- Femoral osteotomy: An osteotomy is a surgical procedure that involves cutting and reshaping of a bone. The femur is cut at the end close to the hip joint and realigned so that it forms a normal angle. This improves the distribution of force placed on the joint and prevents wear-and-tear of the cartilage.
- Hip arthroscopy: Arthroscopy, also referred to as keyhole or minimally invasive surgery, is a procedure in which an arthroscope is inserted into a joint to check for any damage and repair it simultaneously. Hip arthroscopy is a surgical procedure performed through very small incisions to diagnose and treat various hip conditions.
- Core decompressionof the femoral head:
Core decompression of the femoral head has been utilized to delay or prevent the need for hip arthroplasty in patients with early stages of AVN. While many theories have been formulated for why core decompression can be effective, the most accepted theory is that the formation of a core tract allows a drop-in marrow pressure, which may reinstitute normal blood flow and allow new bone formation. In precollapse stages (0-II by Ficat5 and 0-III by Steinberg et al. staging methods), core decompression of the femoral head has been shown to be successful both clinically and radiographically when compared to nonoperative treatments.
Core decompression for osteonecrosis of the femoral head can be effectively performed with hip arthroscopy. In addition, the technique provides a method to address both the AVN and coexistent hip disorders in the same operation – namely labral pathology and cam and pincer lesions associated with FAI.
The various hip preservation surgeries for severe hip pain and dysfunction in young and active patients have been found to be beneficial, and also avoid or delay the need for hip replacement surgery.