Hip Preservation vs. Hip Replacement: Extending the Life of Your Hip

You may have heard of hip replacement, but do you know what hip preservation is?

Hip preservation is a specialized area of orthopaedics. Surgeons address structural deformities and repair damaged parts of the hip joint rather than replace it with an artificial joint. Emory Healthcare Orthopaedics & Spine Center is taking a leading role in this emerging field to help people maintain active lifestyles and the hips they were born with.

“Hip preservation is in relative infancy compared to other areas of orthopaedics,” says Brian Muffly, MD, orthopaedic surgeon. “It was largely born out of work in Switzerland and has really taken off in the last 10 to 15 years.”

Over the years, doctors have increased their understanding of the hip, the ball-and-socket joint that connects the thigh bone to the pelvis. They’re better able to recognize, diagnose and treat underlying issues that would otherwise lead to early degeneration of the hip joint.

Dr. Muffly trained through dual fellowships on care and treatment of the hip—adult hip and knee reconstruction, as well as hip preservation. “It’s uncommon for orthopaedic surgeons to do two fellowships, and there are very few people who’ve had a dedicated year focused only on hip preservation,” he points out. “I intend to help establish Emory Healthcare as a leader in hip preservation in the Southeast and beyond.”

Hip preservation focuses on identifying and fixing issues to extend the life of a patient’s current or “native” hip joint. This procedure is often used with younger patients.

Hip replacement involves inserting a new, artificial hip in an open surgery. This is generally preferred in older patients or those with advanced degenerative changes in the joint and are no longer candidates for preservation surgery.

The benefits of hip preservation include:

• Delaying or eliminating the need for a hip replacement
• Improving quality of life
• Increasing functionality and mobility
• Reducing pain 

“A lot of our patients are constantly thinking about their hip pain throughout their daily activities,” Dr. Muffly says. “We’re trying to get them thinking about their hips less and, in doing so, improve their quality of life and functionality.”

Hip preservation surgery is an umbrella term for several different hip surgery procedures that treat a variety of issues. Some of the most common conditions treated include:

• Abductor and hamstring tendon repairs (in the hip muscles)
• Hip arthroscopy to treat hip impingement
• Osteotomies of the femur or tibia (shin bone) to correct bone deformities and realign the limb
• Periacetabular osteotomy (PAO hip procedure or Ganz osteotomy) to reorient the hip socket to better cover the ball
• Surgical hip dislocation to fix complex deformities by providing a 360-degree view of the hip

Some surgeries are minimally invasive; patients can go home the same day. Physical therapy is typically an important part of the recovery process, helping patients regain mobility and build strength in the joint. On average, full recovery for hip preservation takes a few months.

Most doctors will first recommend conservative treatment options before discussing surgery. These can include:

• Activity modifications
• Anti-inflammatory medications
• Physical therapy and home exercise programs
• Injections such as steroids or platelet-rich plasma (PRP)—which is a therapy that uses a patient’s own blood platelets injected into an injured area to reduce pain and encourage healing

“In some cases, these conservative options don’t do enough to address a patient’s pain and decreased functionality,” Dr. Muffly says. “At that point, we discuss hip preservation surgery.”

Hip preservation can help people under age 50 with hip conditions, pain and limited hip joint function. “Many of our patients are in the prime functional decades of their lives—ranging from the late teenage years to their 40s,” Dr. Muffly says. “They don’t want pre-arthritic hip pain to impact their quality of life.”

Hip preservation aims to keep the hip joint healthy and functional for as long as possible. It reduces pain and increases function so you can stay active. Helping to prevent joint damage and arthritis can delay or eliminate the need for a hip replacement.

It’s important to note doctors usually won’t recommend hip preservation if the patient has significant cartilage wear or osteoarthritis. Osteoarthritis is the most common type of arthritis, and happens when the protective cartilage in your joints wears down over time, causing pain, stiffness and swelling. Other treatment options, such as total hip replacement, may be more effective.

Hip preservation can treat many conditions. These include:

• Avascular necrosis: When part of the ball at the top of your femur loses blood supply and dies, potentially causing the ball to lose its spherical shape.
• Femoral version abnormalities: When your femur rotates too far inward or outward, it can lead to early degeneration of the hip joint.
• Hip bursitis: Inflammation of the bursa (the fluid-filled sac on the outside of the hip joint) causes pain.
• Hip dysplasia: When your hip socket doesn’t develop normally and inappropriately covers the ball. It can lead to joint degeneration and early arthritis.
• Hip impingement: An abnormal contact between your thigh bone and the socket causes pain and limited range of motion.
• Labral tears: Tear in the fibrocartilage structure that lines the rim of your hip socket. They’re often due to hip dysplasia, hip impingement or an abnormality. 
  
• Snapping hip syndrome: A snapping sensation around the hip joint occurs when a muscle or tendon slides over a prominent part of the bone.
• Residual pediatric hip disease: Childhood/adolescent hip conditions such as Perthes and slipped capital femoral epiphysis (SCFE) can cause persistent pain and hip deformity into adulthood.
• Tendon tears: Damage to the abductor or hamstring tendons around the hip can cause weakness and pain.

As one of the few hip preservation leaders in the Southeast, Emory Healthcare attracts patients from around the nation. People from Colorado, Texas, South Carolina, Alabama and Tennessee have come to see Dr. Muffly.

“I see more complex hip patients who may not have received an accurate diagnosis or the appropriate procedure,” he says. “I try to explain why they’re having pain or functional limitations and offer treatment strategies to address their symptoms.”

One recent patient was a 40-year-old executive whose multiple hip arthroscopy procedures had failed. She continued to struggle with pain. After Dr. Muffly performed a femoral derotation osteotomy—a surgical procedure that involves cutting and rotation the bone to its correct alignment—her preoperative pain disappeared within two weeks.

Emory Healthcare’s Orthopaedics & Spine team takes a collaborative approach to offer comprehensive care. The team works with musculoskeletal radiologists, physical therapists trained in hip preservation and other specialists.

“The people and patient-first culture at Emory truly set it apart,” Dr. Muffly says. “We are continually optimizing our service and clinic to enhance patient care.”

As a hip preservation specialist, Dr. Muffly aims to grow hip care at Emory. “I love the hip. I want to be able to take care of the hip from adolescence to the grave.”

If you’re suffering from constant joint pain, talk with one of our orthopaedic specialists at one of our many Emory Healthcare Orthopaedics & Spine locations. Whether you have a sports injury, are experiencing constant hip or other joint pain or need a second surgical spine opinion, our specialists can provide tailored treatment options to get you back to feeling your best. Schedule online or call 404-778-3350.