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Hip preservation is a type of surgical intervention that delays or prevents the onset of arthritis and, later, the need for a hip replacement. The procedures were typically performed on older adults. Today, however, hip preservation is a relatively new treatment that's being used on younger patients who are suffering from severe hip pain.
People in their late teens through early mid-life whose activities involve extreme hip motions (e.g., hockey, gymnastics and soccer) can develop a condition called femoroacetabular impingement (FAI). In FAI, the ball and socket of the hip joint rub together abnormally, causing damage to the cartilage. Some patients are predisposed to FAI due to a past history of pediatric hip disorders or hip fractures. Others develop FAI because they were born with bones in their hips that have an abnormal shape.
Symptoms include hip pain, especially with twisting activity such as cutting or pivoting maneuvers in athletics, getting in and out of a car, putting on shoes and socks and getting up from a seated position. Pain can also occur with sitting for prolonged periods of time or after performing rigorous athletic activities. Range of motion can be limited and lead to difficulty sitting with legs crossed.
We reach a diagnosis using a combination of medical history, physical exam and imaging. An X-ray provides initial measurements. A CT scan shows a more detailed perspective in a three-dimensional structure of the hip. An MRI detects lesions such as labral tears and cartilage damage, which are commonly associated with FAI. An injection of cortisone directly into the hip joint may also be used to help us determine if the patient’s pain is coming from the joint itself or from a different location.
We generally use arthroscopic techniques to address FAI. This surgical technique involves using minimally invasive incisions to address the hip disorder, including the soft tissue and bony abnormalities associated with FAI. This procedure is very effective for relieving pain while also preserving the hip joint and its function. The surgery takes about two to three hours. Patients are on crutches for three to four weeks and undergo physical therapy to assist in healing. They can often return to their sport within four to six months.
In addition to the more standard rotator cuff repairs and ACL reconstructions, we also perform cartilage repair and restoration procedures for the hip, shoulder and knee. Most of our understanding of cartilage preservation procedures comes from our experience in the knee, but the same principles can also be applied to other joints in the body. For example, in the hip, we can offer some cartilage repair and restoration procedures that are performed arthroscopically, while larger lesions will likely benefit from a surgical dislocation. For those with advanced arthritis, total joint replacement is also an option.
Sara Llibre rekindled her athletic career to celebrate her 50th birthday, and in a few years she was an ironman. However, soon the training was hard on her hip, so after reaching out to Dr. Sherwin S.W. Ho, repaired the tear and addressed the biomechanical defect (impingement) by reshaping the bones that rubbed against each other. After three months, the triathlete was swimming, biking and running again.