Total hip arthroplasty after hip preservation surgery: Outcomes and challenges

Hip preservation surgery (HPS) is increasingly performed in young and active patients with the aim of delaying or avoiding total hip arthroplasty (THA). Despite advances in preservation techniques, a proportion of patients eventually progress to end-stage hip disease and require conversion to THA. Performing THA after prior HPS presents unique challenges because of altered anatomy, retained hardware, soft-tissue scarring, and compromised bone quality. This narrative review evaluates the existing literature on THA following various hip preservation procedures, including hip arthroscopy, periacetabular osteotomy, femoral osteotomies, and core decompression. A comprehensive review of PubMed-indexed studies was undertaken to assess indications for conversion, preoperative considerations, intraoperative challenges, surgical strategies, and clinical outcomes. Available evidence suggests that conversion THA after HPS is generally more technically demanding than primary THA, often resulting in longer operative times and increased blood loss. Nevertheless, most studies report significant improvements in pain relief, function, and patient satisfaction, with short-to mid-term outcomes comparable to those of primary THA. However, patients with a history of complex reconstructive procedures, particularly femoral or pelvic osteotomies, may experience higher rates of complications and revision surgery. Successful outcomes depend on meticulous preoperative planning, detailed understanding of previous interventions, and appropriate surgical expertise. Although current evidence supports THA as a reliable and effective option following failed HPS, further high-quality, long-term studies are needed to better define outcomes, identify risk factors for complications, and optimize surgical techniques in this challenging patient population.