Doctor speaking with elderly patient

Hip preservation techniques are the preferred option for treating adolescents, young adults and active adults who are looking for strategies other than traditional hip replacement surgery.

Hip preservation surgery encompasses a variety of techniques. These include cartilage and soft tissue repairs or reconstructions, joint reshaping and structural reorientation procedures intended to spread weight-bearing forces evenly throughout the joint to keep the hip healthy.

Penn Medicine's orthopaedic specialists have advanced training in hip preservation techniques, including all types of interventional, arthroscopic and open procedures. We believe in taking a patient-centered approach to alleviate pain and improve function across the spectrum of hip care.

Our experts focus on restoring the structure and function of the hip joint, while minimizing pain that may happen with daily activities, recreational activities and athletics.

To develop the right restoration strategy, we will first ask for a detailed history of your hip pain. This includes imaging tests, such as X-rays, MRIs and 3-D CT scans, which show the anatomy and structure of the hip joint, quality of the cartilage and movement mechanics.

Preventing and Postponing Hip Replacement

At Penn Medicine, we have a specialized Hip Preservation Center devoted to postponing or eliminating the need for hip replacement.

Hip preservation treatment options include a variety of non-surgical and surgical options for patients who have healthy cartilage. The goal is to correct issues related to joint anatomy, including bones and soft tissues of the hip to prevent further cartilage damage.

After a thorough review of your medical history and careful physical examination, we typically will suggest a variety of treatment options, depending on the underlying cause of the pain.

Hip Preservation Treatment Options

The following are treatment options your doctor may discuss with you:

Abductor tendon (gluteus medius/minimus) tear repair - These arthroscopic and open techniques help repair and reconstruct tendon tears of the hip.

Advanced cartilage repair and restoration - These specialized arthroscopic and open techniques treat focal cartilage injuries in the hip.

Arthroscopic hip labral repair/reconstruction - We may recommend one of several surgical techniques to repair a hip labral tear. If the existing labrum is in such poor condition that it cannot properly protect the hip joint, we may recommend a labral reconstruction.

Arthroscopic and open chondral restoration procedures - Arthroscopic and open surgery is performed to treat chondral injuries when non-surgical options are ineffective and pain persists. The spectrum of cartilage damage varies from mild to severe. We will recommend the right option for you.

Core decompression - This minimally invasive technique addresses avascular necrosis (AVN or osteonecrosis) of the hip, knee and shoulder. The procedure involves decompressing areas of dead bone tissue and placing stem cells harvested from a patient's own body into the hip to stimulate the growth of new, healthy bone tissue.

Femoral osteotomy - This is an open surgery to change the shape of the femur to improve gait mechanics.

Free-fibular vascularized bone grafting - This specialized open technique addresses avascular necrosis, which is death of bone tissue due to a lack of blood supply.

Hip arthroscopy - This is a minimally invasive surgery to address damage deep inside the hip joint, such as cartilage injury and areas of femoroacetabular impingement (FAI).

Microfracture surgery - This arthroscopic technique to treat chondral injuries involves stimulating the formation of new articular cartilage by drilling numerous tiny holes in the bone underneath the damaged cartilage. This results in the formation of blood clots within the damaged cartilage, which stimulates the growth of new cartilage known as fibrocartilage.

Periacetabular osteotomy (PAO, Ganz osteotomy) - This is an open surgery to reorient the hip socket to improve coverage of the head of the femur by the socket, particularly for dysplastic (shallow) hips.

Surgical hip dislocation - During this open surgery, the hip joint is dislocated from the socket, without reducing the critical blood supply, to address severe deformities and cartilage damage.

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