The evolution and concepts of joint-preserving surgery of the hip
1Schulthess Clinic, Department of Orthopaedics, Lengghalde 2, 8008 Zürich, Switzerland.
Insights
Joint-preserving hip surgery offers new options for hip conditions like developmental dysplasia. These techniques may prevent or slow osteoarthritis progression by addressing mechanical causes.
Area of Science:
- Orthopedic Surgery
- Hip Preservation
- Regenerative Medicine
Background:
- Total hip replacement largely replaced joint-preserving hip surgery.
- Childhood hip conditions like hip dysplasia, slipped capital femoral epiphysis, and Perthes' disease can have long-term consequences.
- Femoroacetabular impingement is a key factor in osteoarthritis development.
Purpose of the Study:
- To review recent advancements in joint-preserving hip surgery techniques.
- To explore the application of these techniques in treating sequelae of childhood hip conditions.
- To discuss the role of these procedures in preventing or decelerating osteoarthritis.
Main Methods:
- Review of modified pelvic osteotomy techniques.
- Discussion of intracapsular procedures including surgical hip dislocation and arthroscopy.
- Analysis of femoroacetabular impingement as an etiological factor.
Main Results:
- Modified joint-preserving techniques provide new surgical treatment options.
- These methods are effective for sequelae of developmental dysplasia, slipped upper femoral epiphysis, and Perthes' disease.
- Recognition of mechanical causes allows for earlier intervention to prevent osteoarthritis.
Conclusions:
- Joint-preserving hip surgery is experiencing a resurgence with modified and new techniques.
- These procedures offer promising options for managing hip conditions and potentially preventing osteoarthritis.
- Early identification and treatment of mechanical hip issues are crucial for long-term joint health.
Abstract:
The use of joint-preserving surgery of the hip has been largely abandoned since the introduction of total hip replacement. However, with the modification of such techniques as pelvic osteotomy, and the introduction of intracapsular procedures such as surgical hip dislocation and arthroscopy, previously unexpected options for the surgical treatment of sequelae of childhood conditions, including developmental dysplasia of the hip, slipped upper femoral epiphysis and Perthes' disease, have become available. Moreover, femoroacetabular impingement has been identified as a significant aetiological factor in the development of osteoarthritis in many hips previously considered to suffer from primary osteoarthritis. As mechanical causes of degenerative joint disease are now recognised earlier in the disease process, these techniques may be used to decelerate or even prevent progression to osteoarthritis. We review the recent development of these concepts and the associated surgical techniques.
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