Patient Information: Hip Preservation Surgery, Phillip Graehl, MD

Hip Preservation Surgery

The ideal hip joint is a ball and socket joint matching a spherical ball with a spherical socket.

Up until recent years any deviations from a perfectly spherical ball in a hip joint were often felt to be changes brought about by arthritic conditions within that hip joint. These alterations in bone contour were often labeled as bone spurs like those that are frequently seen in almost all joints that undergo arthritic change.

It has now been discovered that these changes in bone shape may actually be the cause of arthritis in many (but not all) hips that develop arthritis. The way the abnormal process works is as follows. If a ball that is not spherical is matched within a spherical socket there will be points within the range of motion where a part of the ball will have too large a diameter to roll into the socket and this part of the ball will then impinge with the edge of the socket.

After many years of this type of impingement (Femoral-Acetabular Impingement or FAI) the cartilage at the edge of the socket is damaged. This damage to the cartilage as it progresses brings on the onset of arthritis. Once arthritis has set up within the hip it cannot be fully eradicated, and will progress over time, often times leading to the need for a hip replacement.

If this impingement can be detected early enough Hip Preservation Surgery can be performed in which the cartilage is repaired and the ball is contoured into a spherical shape thus eliminating further impingement and often preserving the joint from an arthritic fate.

The real challenge with FAI is to diagnose it before arthritic damage has occurred. This is not always possible because many people will not have any painful symptoms until after arthritic damage has occurred. Many of these patients will in retrospect note that they have never been as “flexible” around their hips as other people; that is, they could never do the splits or sit “Indian style” like their peers. They may have had difficulty crossing their legs to tie their shoes, or other limitations of hip motion.

Pain in the hip area (typically the groin) may be the first sign of FAI and should be investigated if it persists. Trauma to a hip that is “out of round” may produce a sudden cartilage injury as well.

Hip Preservation Surgery is an arthroscopic surgical technique where through two 1cm incisions the hip joint can be accessed, labral (cartilage) tears are repaired or removed, and the ball is reshaped into a spherical ball which allows the hip to enjoy a full range of motion without further impingement against the edge of the socket.

Dr. Graehl performs Hip Preservation Surgery for those patients with appropriate indications. He is happy to evaluate your hip problem to determine if you would benefit from Hip Preservation Surgery, and possibly prevent a serious arthritic condition from developing in your hip.

Phillip Graehl, MD

OrthoTexas - Carrollton and Flower Mound