Joint-Preserving Surgery for Osteoarthritis of the Hip
Surgeons at NYU Langone’s Joint Preservation and Arthritis Center specialize in procedures to preserve the hip joint, which may help people with prearthritic conditions prevent osteoarthritis from developing for years or decades.
Prearthritic conditions occur when structural changes develop in the hip joint. For example, a tear in the labrum, which is a ring of cartilage around the outside of the hip joint, may cause the femoral head, the ball-shaped top of the thighbone, to align improperly in the joint socket. Hip impingement syndrome, in which the bones of the hip are abnormally shaped, may also lead to friction in the joint. This unusual friction may result in pain and discomfort, an eventual loss of cartilage all over the hip joint, and the development of osteoarthritis.
As recently as five years ago, there were few options available to prevent the onset of osteoarthritis of the hip. Today, NYU Langone doctors often recommend surgery if they diagnose a prearthritic condition based on the results of MRI scans or diagnostic imaging tests. Procedures can be performed to delay or prevent the progression of hip arthritis. Our doctors have the experience to diagnose a prearthritic condition before it advances to osteoarthritis.
Hip arthroscopy is a procedure that allows a surgeon to access the hip joint using small incisions, avoiding contact with nearby muscle and other soft tissues. Your doctor may recommend arthroscopy to repair a torn labrum, remove bone spurs that develop on the femoral head, and remove any loose pieces of cartilage or other tissue in the joint.
To perform arthroscopy in the hip, doctors use general or regional anesthesia. A surgeon makes an incision in the hip and inserts a pencil-sized instrument called an arthroscope into the joint. The arthroscope has a light and a camera lens on its tip and broadcasts magnified images of the inside of the hip joint on a monitor so the doctor can see it clearly.
The surgeon uses the arthroscope to locate the area in the hip joint that needs attention and inserts surgical instruments through a second small incision to retrieve loose pieces of cartilage or other tissue, remove bone spurs, or repair the labrum. After the procedure, the surgeon closes the incisions with stitches.
You can expect to return home the same day as the surgery. Some people experience relief from painful symptoms almost immediately after the procedure.
If cartilage has begun to wear away, microfracture surgery may help stimulate the growth of new cartilage by increasing the blood supply to the surface of the joint bone.
Doctors use general or regional anesthesia and perform this minimally invasive surgery using an arthroscope. After the scope is in place, surgeons insert a tool through a second incision to make tiny holes, or microfractures, in the bone beneath the cartilage layer. These microfractures allow more blood to flow to the cartilage layer, which stimulates the growth of new cartilage.
After surgery, your doctor provides crutches so you can move around without putting any weight on the affected hip for six weeks. This allows new cartilage to form. During this time, a physical therapist helps you maintain flexibility with stretching exercises and movements designed to restore range of motion in the hip.
After six weeks, your physical therapist adds weight-bearing exercise to your routine in order to build strength in your leg and back muscles. Doctors recommend at least 12 weeks of physical therapy and assess your progress every four weeks.
Periacetabular Osteotomy and Femoral Osteoplasty
Periacetabular osteotomy, also known as Ganz osteotomy, is a procedure to reposition the hip socket, or acetabulum, in order to provide a better connection for the ball-shaped top of the thigh bone, called the femoral head. If the acetabulum is too shallow, the ball of the femoral head can’t fit snugly into the hip joint, causing instability and dysfunction.
Over time, poor alignment can lead to the erosion of the cartilage lining and osteoarthritis. This is most common in people born with hip dysplasia, in which the bones of the hip joint do not fit well together. Without treatment, this misalignment may lead to cartilage damage and premature hip osteoarthritis.
In some instances—for example, in people with hip impingement syndrome—the femur may be oddly shaped and contribute to prearthritic joint damage. Your surgeon may perform femoral osteoplasty—in which the femur is reshaped to better fit the acetabulum—by itself or with periacetabular osteotomy.
A surgeon performs surgery using general anesthesia. He or she makes an incision on the front of the hip to access the joint, then separates the socket-shaped acetabulum from the rest of the pelvic bone. The acetabulum is rotated so it matches the alignment of the ball-shaped femoral head and fixed into this new position with metal screws. If the surgeon performs femoral osteoplasty, he or she uses special surgical instruments to reshape the femur. Doctors close the incision with stitches or staples.
After surgery, you remain in the hospital for several days while the bone begins to heal. During this time, our pain management specialists ensure that you recover comfortably and have the medication you need. In addition, a physical therapist visits you and assesses your range of motion. He or she also helps you stand and walk using crutches or a walker.
Doctors schedule a follow-up appointment to remove stitches or staples two weeks after surgery. Crutches or a cane are required for at least six additional weeks. Doctors recommend starting physical therapy to rebuild strength and range of motion in the hip as soon as you can walk without pain.