Hip Preservation

Through a unique collaboration with McGovern Medical School at UTHealth Houston, affiliated orthopedic surgeons and the Memorial Hermann sports medicine team provide a full range of surgical and nonsurgical treatments to restore and preserve patients’ natural hip function.

The multidisciplinary team of surgeons, musculoskeletal imaging experts, specialized hip physical therapists and other health care providers work collaboratively to tailor a treatment regimen to treat both the symptoms and the underlying causes of hip pain. The goal of treatment is to maximize the patient’s natural hip function using the most effective, least invasive option. Often, a patient can be treated with non-operative techniques, such as physical therapy, injections or activity modification. If surgery is required, our team has the ability to perform the full spectrum of hip preservation surgeries, from minimally invasive hip arthroscopy to complex hip osteotomies.

Hip Anatomy 101

The hip is a ball-and-socket joint comprised 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 allow smooth and near frictionless movement of the hip joint, the articulating surfaces of the femur head and acetabulum are covered by glossy articular cartilage. The socket is also lined with the labrum, which is a soft cartilage ring that improves hip stability during weight-bearing tasks. Injury, wear-and-tear and certain diseases can result in the wearing away of the cartilage and injury to the labrum, causing painful rubbing of bones or pinching within the hip.

What is Hip Preservation?

The goal of hip preservation is to provide timely treatment for non-arthritic hip pain before the hip has suffered enough damage to require a total hip replacement. Interventions begin with simple activity modifications and therapeutic exercises but can extend to surgical correction if conservative management is unsuccessful.

The various hip preservation treatments for hip pain and dysfunction in young and active patients have been found to be beneficial and help avoid or delay the need for hip replacement surgery. Determining the best approach is individualized to each patient, based on careful review of imaging, specific and thorough examination, previous medical history, and individual patient goals and preferences.

Conditions Treated

Some of the conditions indicated for hip preservation surgery include:

Femoroacetabular impingement (FAI)– Premature contact between the femur and pelvis due to abnormal bone shape leading to cartilage damage and pain.
Hip dysplasia– Congenital hip condition characterized by a shallow hip socket leading to hip instability, cartilage damage, and pain.
Labral Injury– Fraying, tear or separation from the underlying cartilage leading to instability, pinching, clicking/catching and pain.
Avascular necrosis– Disruption of blood flow to the hip joint leading to death of bone tissue, potential collapse of the femoral head and early-onset arthritis.
Hip dislocation– a traumatic injury in which the head of the femur breaks out of the socket.
Pelvic Avulsion Fractures – Often seen in adolescent athletes, these fractures occur when the attachment point of a muscle breaks away from the pelvis due to a forceful contraction.
Tendinopathies and Muscle Strains – injuries and pain from the muscles and tendons attached to the hip and thigh.

Hip Preservation Physical Therapy Management

Physical therapy treatment will vary widely depending on the type of injury, acuity of symptoms, pain levels, and baseline patient measurements of strength, range of motion, and physical function. Listed below are some of the more common treatments that patients can expect to receive.

Manual Therapy – any hands-on treatment provided by your physical therapist including but not limited to joint mobilizations, passive range of motion, manual stretching, and soft tissue manipulation (i.e. Graston or other instrument-assisted soft tissue manipulation).

Strength Training – physical training exercises geared toward increasing strength, muscular endurance, and motor coordination. This is often the largest portion of a physical therapy session, and patients will be instructed on which exercises to continue with at home when not in physical therapy.

Dry Needling– a skilled intervention using a thin monofilament needle to penetrate the skin and stimulate muscular tissues to help manage neuromuscular pain and movement issues.

Education – tailored education will be provided to each patient regarding the specifics of their diagnosis, their expected prognosis, and the therapy plan of care. The physical therapist will also provide recommendations on what activities or positions to avoid, pain management strategies, and suggestions on how to stay physically fit and active during recovery.

Gait training – teaching and training of normal walking mechanics to normalize patient gait pattern after surgery or a prolonged period of pain and dysfunction. At some locations this training will be supplemented with the use of an anti-gravity treadmill (i.e. Alter-G).

Hip Preservation Surgery Techniques

Hip arthroscopy – A minimally invasive surgical procedure in which a surgeon inserts a narrow tube through small incisions into the hip joint to visualize, assess, and treat problems inside and around the joint.

Periacetabular osteotomy (PAO) – A surgical procedure to treat hip dysplasia that involves cutting the acetabulum from the pelvic bone and repositioning it with screws to provide improved coverage and weight distribution on 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 – A technique that involves the dislocation of the hip joint to provide better visualization and access to the inside of the hip joint, which allows the surgeon greater capacity to assess treat a wide variety of injuries and abnormalities.

Femoral osteotomy – A procedure in which the femur is cut at the end close to the hip joint, realigned and pinned to correct for atypical femoral rotation, thereby improving joint stability, minimizing impingement, and decreasing pain.

Hip Preservation Surgery Recovery

After arthroscopic surgery, most patients go home the same day and return to normal daily activities after two months and sporting activities after four to six months. The typical hospital stay for osteotomy patients is two to three days, with about three months before return to normal daily activity and eight to twelve months for full return to higher-level sporting and recreational activities.

Patients who receive any of these surgical interventions will walk with the assistance of crutches after surgery and will often spend six to twelve months in specialized rehabilitation, both under the direct guidance of a physical therapist and on their own at home. Postoperative patients typically require follow-up orthopedic visits at several time points after surgery to monitor progress and guide activity recommendations based on repeat X-rays and reports from physical therapy.

Where to Get Treatment

Consultation with a hip preservation physical therapist is available with the providers below. No referral is needed before scheduling your initial assessment.