Hip Preservation Conditions and Treatment

Specialists at the Penn Hip Preservation Center have advanced training in hip preservation techniques, including all types of arthroscopic and open procedures. We use both non-surgical and surgical approaches to restore the structure and function of the natural hip joint and minimize pain that may occur with daily or recreational activities, or athletics.

Conditions Treated by the Penn Hip Preservation Center

There are several hip conditions and underlying causes that are treated with hip preservation techniques at Penn Orthopaedics. Our center provides comprehensive treatment for the following:

• Avascular necrosis
• Cartilage injury
• Femoral version abnormalities
• Hip dysplasia (developmental/congenital dysplasia)
• Hip impingement (or femoroacetabular impingement)
• Hip pain
• Hip labral tear
• Osteochondritis Dissecans (OCD)
• Shallow acetabulum

Diagnosing Hip Problems

Diagnosis is crucial to the development of your treatment plan. When diagnosing hip problems, we take into consideration your age, activity level, treatment goals, and priorities. We also evaluate the anatomy and structure of your hip joint and your movement mechanics. The health of your cartilage is also considered, as this plays a significant role in determining your eligibility for hip preservation treatment. Advanced imaging tests are used to make an accurate diagnosis and may include:

• X-rays
• MRIs
• 3-D CT scans

Once we've identified the underlying cause of your hip problem, we'll develop a treatment plan that aims to restore the structure and function of your hip joint, prevent further damage, and minimize or eliminate pain. We then take the time to explain this plan thoroughly so that you understand your diagnosis, the proposed treatment, and what recovery will look like. This ensures you have all the information you need to make an informed decision regarding your treatment.

Hip Preservation Treatment Options

The Penn Hip Preservation Center offers the full range of non-surgical and surgical approaches for hip conditions in young and active adults.

Non-Surgical Treatment Options

When treating patients, our preference is to begin with a conservative approach. There are several non-surgical alternatives to surgery that we may recommend, including:

• Physical therapy
• Anti-inflammatory medication
• Injections (local or steroids)
• Modified or reduced activity
• Platelet rich plasma

Hip Preservation Surgery

If your condition doesn’t improve with non-surgical treatment, we may recommend hip preservation surgery. In addition to reducing pain and improving overall function, hip preservation surgery has the added benefit of lowering the risk of arthritis and joint replacement in patients who have good cartilage. Patients with cartilage that is damaged who undergo hip preservation surgery may be able to delay hip replacement surgery by several years.

The Penn Hip Preservation Center is a regional leader in the treatment of both common and uncommon hip problems. Hip preservation surgeries offered by the Penn Hip Preservation Center include:

• Abductor tendon (gluteus medius/minimus) tear repair: A procedure using arthroscopic and open techniques to repair and reconstruct tendon tears in the hip.
• Advanced cartilage repair and restoration: Performed in combination with other hip preservation procedures, these treatments use arthroscopic and open techniques to repair focal cartilage injuries in the hip. Specific treatments offered by our specialists include:
  • Microfracture
  • Osteochondral autograft and allograft procedures
  • Osteochondral Allograft Transplantation
  • Chondrocyte implantation procedures
• Core decompression: A minimally invasive technique to address avascular necrosis (AVN or osteonecrosis) of the hip. This procedure involves decompressing areas of dead bone tissue and, in the same procedure, placing stem cells harvested from the patient's own body into the hip to stimulate the growth of new, healthy bone tissue.
• Femoral osteochondroplasty: A procedure to reshape or remove bone from the head and neck of the femur so that it fits more naturally in the hip socket.
• Femoral osteotomy: An open surgery to change the shape or orientation of the femur to improve gait mechanics.
• Femoral retroversion: An open surgery to reorient a femur that is rotated too far forward.
• Free-fibular vascularized bone grafting: A specialized open technique to address avascular necrosis.
• Hip arthroscopy or revision: A minimally invasive surgery to address damage deep inside the hip joint, such as cartilage injury and areas of femoroacetabular impingement (FAI).
• Hip dysplasia treatment: A distinguishing feature of our center is the use of periacetabular osteotomy to correct hip dysplasia. We are the only providers in the region offering this approach for hip dysplasia.
• Hip impingement treatment: A series of procedures to remove bone that is pinching or bumping into the labrum or to correct bone deformities.
• Hip labral tear repair: A treatment to repair or reconstruct the labrum and to address the underlying cause of the labrum tear, whether it's hip impingement or hip dysplasia. It's important to treat these underlying conditions as they often lead to arthritis and the need for hip replacement.
• Periacetabular osteotomy (PAO)/Ganz osteotomy: An open surgery to reorient the hip socket to improve coverage of the femoral head by the socket, particularly for dysplastic (shallow) hips. This procedure may also be performed as an anteverting PAO to correct a hip socket that is facing toward the back.
• Pincer osteochondroplasty: A procedure to remove excess cartilage from the hip socket so that the femoral head fits more naturally.
• Subspine decompression: A procedure to remove excess bone from the anterior inferior iliac spine. It can be performed arthroscopically or as an open procedure.
• Surgical hip dislocation: An open surgery in which the hip joint is dislocated from the socket, without reducing the critical blood supply, to address severe deformities and cartilage damage.