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Innovative Procedures Help Preserve Hips

Surgeries help treat hip dysplasia and impingement in younger individuals

For young patients suffering from hip dysplasia or impingement, replacement and resurfacing used to be the only treatment options. That’s no longer the case.

Today, Javad Parvizi, MD, joint specialist at the Rothman Institute at Thomas Jefferson University Hospital, performs two innovative procedures that treat pain and loss of mobility by preserving a patient’s native hip joint – rather than replacing or resurfacing it.

And he is the only orthopaedic surgeon in the Philadelphia region and one of only about a dozen in the United States to do so.

“Prior to preservation techniques, patients as young as 14 had no options but to try medications like non-steroidal anti-inflammatory drugs (NSAIDs), or to have a replacement or resurfacing procedure,” says Dr. Parvizi, who is also associate professor of Orthopedic Surgery at Jefferson Medical College, Thomas Jefferson University. 

“A replacement is basically cutting the joint and throwing it away, so if five or 10 years from now we develop a way to restore or substitute cartilage, or discover other forms of treatment, replacement patients will not be candidates,” adds Dr. Parvizi. “Preservation is a win-win for younger, qualified patients, not only because it reduces pain and restores mobility, but also because it allows for a wide range of future options if arthritis progresses down the road.” 

These options include both hip resurfacing and total hip replacement because the patient comes out of surgery with their own anatomy intact. Unlike hip replacement or hip resurfacing, hip preservation does not require implants or devices to be positioned in place of the natural joint. 

Dr. Parvizi performs two types of hip-preserving procedures – periacetabular osteotomy and femoroacetabular osteoplasty.

Relief for hip dysplasia
Hip dysplasia is a condition where the head of the femur (the thigh bone) only loosely or partially fits into the acetabulum (concave socket in the pelvis) and the femoral head or acetabulum is misshapen, causing abnormal wear and tear within the joint as it moves.

Periacetabular osteotomy can help some patients with hip dysplasia, which is caused by a combination of genetic and environmental factors and is one of the leading causes of degenerative arthritis. 

As the more complicated of the two procedures, the periacetabular osteotomy usually involves making several cuts in the pelvis to realign the angle of the acetabulum so that the femoral head can fit properly into place. It may also involve smoothing of a misshapen femoral head to eliminate the friction caused by its movement. Dr. Parvizi says that recovery takes up to three months.

Treating hip impingement
Hip impingement – or, more precisely, femoral acetabular impingement – is a disorder that’s increasingly recognized as a cause of hip pain in active adults and a previously unrecognized cause of arthritis in young adults. Impingement is caused by a lack of room between the neck of the femur and the rim of the acetabulum, causing the neck and rim to jam together as the hip is flexed (as in sitting or running). 

As Dr. Parvizi explains, this jamming leads to pain manifested in the hip or groin region and may lead to early degenerative arthritis of the hip. 

To help patients with this condition, Dr. Parvizi developed the second surgery – a femoroacetabular osteoplasty. This procedure focuses on smoothing the surface in the space between the neck and the head of the femur, and requires a recovery of about six weeks.

Are you a candidate?
To be eligible for either of these procedures, patients should be under 50 years of age. And if arthritis is already present, it must not have progressed past stage three. 

Though the preservation procedures can be more technically difficult, there are clear benefits to keeping your own joint, says Dr. Parvizi. 

“Patients can go back to regular activities without limitations, and there is less risk of post-operative infection than with replacement surgery,” he notes. “Also, there is little to no risk of the joint dislocating.”

For an appointment, call 1-800-JEFF-NOW
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