Have you been hearing a clicking sound lately combined with pain? It might be your hip. Hip pain can be severe and keep you from living your life. If it’s limiting your activities and restricting your movement, it’s time to consider your options and talk with your doctor. 

Hip pain is common among adults of all ages, whether from running, overuse, sports or an injury. Hip pain is typically in one of three locations: front, side or back. It may be felt in or around the hip joint, groin, thigh or knee. 

Does hip pain and clicking sounds mean a hip replacement is necessary? Not always. Nebraska Medicine orthopaedic surgeon Justin Greiner, MD, explains that hip preservation surgery is an option to bypass the need for hip replacement surgery.

What is hip preservation? 

“Hip preservation is a surgical treatment which aims to preserve the hip long term,” says Dr. Greiner. “The ultimate goal is to prevent the development of arthritis and the need for a hip replacement.”

Hip preservation can include arthroscopic and open hip surgery, such as periacetabular osteotomy (PAO). 

Hip arthroscopy

“Hip arthroscopy removes areas of bony impingement that can damage the cartilage and labrum, which can lead to osteoarthritis or hip replacement,” says Dr. Greiner. 

A minimally invasive technique that treats joint damage, hip arthroscopy helps with pain and pre-arthritic issues that don’t require a total joint replacement. 

Periacetabular osteotomy (PAO)

PAO treats hip dysplasia (a hip socket that doesn’t cover the ball portion of the thigh bone) and decreases the risk of cartilage injury. It changes the angle of the hip socket to fit the femoral head more securely.

Both hip arthroscopy and PAO are hip preservation surgeries that can be performed in isolation or combined. Dr. Greiner and fellow Nebraska Medicine orthopedic surgeon Vivek Dutt, MBBS, are the only two surgeons in Nebraska who combine hip arthroscopy and PAO. 

When is hip preservation needed? 

Sometimes, nonsurgical options such as physical therapy, anti-inflammatory medications, or stretching can help in less severe cases. If hip pain persists or worsens, it’s time to see a specialist. Painful hip conditions such as hip dysplasia and hip impingement can cause cartilage or labral injury, such as a tear. When untreated, it can lead to continued pain, arthritis or a hip replacement. 

If these issues haven’t led to advanced arthritis yet, hip preservation may be the best option. An orthopaedic surgeon can help determine the underlying causes of hip pain to rule out arthritis or a broken bone. 

Hip replacement vs. hip arthroscopy

The more well-known procedure is hip replacement, a very successful operation for those who need it. The surgeon removes damaged sections of the joint and arthritis in the hip and replaces them with a metal and plastic prosthetic. A hip replacement can last 25 to 30 years and is recommended for patients with significant osteoarthritis. Most patients can walk without assistance following a hip replacement within six weeks. 

Hip replacement surgery is more invasive and can require an overnight hospital stay. In contrast, hip preservation is minimally invasive and is performed through incisions of less than 1 cm. There’s usually no need for a hospital stay. Hip preservation can help avoid potential hip replacement surgery in the future. 

Which is best for me?

Hip preservation surgery is recommended for those who haven’t developed arthritis. Those with hip arthritis can benefit most from hip replacement. Hip preservation is best for those who:

• Have hip impingement.
• Are between 15 and 45 years old.
• Have been diagnosed with hip dysplasia or labral tear.

While it’s normal to have aches and pains as we get older, there is relief from chronic hip pain. If you’re a good candidate, hip preservation surgery can alleviate pain without replacement, allow you to return to your daily activities and get you moving again.