Am I a Candidate for Hip Preservation Surgery?

Yes, you may be a good candidate for hip preservation surgery if your hip disorder has not progressed to severe joint deterioration. However, the surgeon will evaluate your symptoms, medical history, and imaging to determine whether preserving your natural hip can provide better long-term function than replacement.

At Total Orthopedic & Sports Medicine, our hip specialist, Dr. Nicholas Montemurro, takes a precision-based approach to identifying the right candidates for hip preservation. He reviews both your current condition and your long-term mobility goals before recommending a treatment plan. His goal is to ensure you receive the right procedure at the right stage of your condition, improving the chances of a successful long-term outcome. Call 855-321-6784 to book your appointment.

When Do Doctors Recommend Hip Preservation Surgery? 

Our fellowship-trained orthopedic surgeon, Dr. Nicholas Montemurro, recommends hip preservation surgery if your hip joint has structural damage that can be corrected without hip replacement. By addressing the underlying cause early, he helps protect healthy tissue and preserve your natural joint. As a result, you may achieve better long-term function while delaying or avoiding more extensive surgery.

Before recommending hip preservation surgery, Dr. Nicholas Montemurro reviews the following factors:

The Extent of Joint Damage

Preserving your natural hip depends on the condition of the joint itself. When the supporting cartilage and bone are healthy, the surgeon can often correct the underlying problem without replacing the joint. This improves the chances of long-term success. However, extensive structural damage may require a different surgical approach.

Your Age and Activity Goals

Hip preservation is designed to maintain your natural joint rather than replace it. For that reason, our surgeon evaluates the level of activity you want to maintain in the years ahead. Patients with an active lifestyle often benefit more from preserving the joint whenever appropriate. Moreover, these procedures are most commonly performed in patients aged 15 to 55. In fact, a study on hip preservation reports that younger patients experience greater symptom relief than older individuals. But the final recommendation depends on both your condition and long-term functional goals.

Response to Non-Surgical Treatment

Non-surgical treatment is usually the first step in managing many hip conditions. However, if your symptoms continue despite activity modification, medications, or injections, the underlying structural problem may still exist. In that case, continuing conservative care does not improve your condition. Then our surgeon may recommend hip preservation surgery to address the underlying cause and improve long-term function. According to PubMed Central, persistent pain despite non-surgical treatment often signals an underlying mechanical problem that may benefit from surgical correction.

Cause of Hip Condition

The success of hip preservation depends on treating the correct problem. Conditions such as severe hip impingement and labral tears often require different surgical techniques, even though they can cause similar symptoms. Therefore, identifying the source of the problem is essential to choosing the most appropriate procedure instead of relying on a generalized approach.

Overall Health and Recovery Potential

Hip preservation focuses on protecting the long-term health of your natural joint. However, achieving that goal depends on your ability to heal, regain strength, and complete rehabilitation successfully. Therefore, our hip surgeon evaluates these factors, along with your hip condition, before recommending surgery. It helps our surgeon determine whether you are a good candidate for hip preservation surgery.

Which Hip Problems Can Preservation Surgery Treat?

Hip preservation surgery is commonly used to treat femoroacetabular impingement (FAI), hip dysplasia, labral tears, cartilage injuries, and other correctable structural abnormalities. Addressing these conditions before significant joint deterioration occurs helps preserve your natural hip. It can also improve mobility and reduce pain.

Here’s how these structural hip conditions affect your joint and when hip preservation is recommended:

Femoroacetabular Impingement (FAI)

Femoroacetabular impingement (FAI) develops when extra bone forms around the ball or socket of your hip, causing the joint to move abnormally during certain movements. This repeated friction can gradually injure the labrum and cartilage. Without treatment, everyday activities may place increasing stress on the joint. Rather than simply relieving symptoms, hip preservation surgery reshapes the bone to correct the abnormal mechanics. This reduces abnormal contact and helps protect the natural hip from further damage.

Hip Dysplasia

A healthy hip socket keeps the ball of the joint securely supported throughout movement. Hip dysplasia reduces the support because a shallow hip socket does not fully cover the ball of the joint. It is often identified in patients during their late teens or thirties. Over time, this uneven loading can damage the labrum and cartilage. Hip preservation surgery corrects the structural problem by improving joint coverage. As a result, the hip can move more smoothly while distributing force more evenly.

Labral Tears

The labrum acts as a cushion and stabilizer around your hip joint. When it tears, the joint may lose some of its natural support and move less efficiently. Many people notice catching, clicking, or pain during certain movements. In this case, hip preservation surgery repairs or reconstructs the damaged tissue whenever possible. This helps improve joint stability and preserves healthy cartilage.

Cartilage Damage

Cartilage creates a smooth surface that allows your hip to move with minimal friction. Once it gets damaged, the joint can no longer absorb force as effectively. If the underlying structural problem persists, the damaged area may continue to deteriorate. Hip preservation surgery addresses both the mechanical cause and the cartilage injury when possible. This approach helps preserve the natural joint for as long as possible.

Other Structural Hip Abnormalities

Some hip conditions are less common but can still interfere with normal joint function. They may develop from childhood hip disorders, previous injuries, or anatomical variations that alter the way your hip moves. Although the symptoms may appear similar, the underlying mechanics can vary significantly. A detailed evaluation helps your surgeon identify the exact source of the problem. Once the underlying problem is identified, treatment can be tailored to your specific anatomy and functional needs.

Can Preservation Surgery Help You Avoid Hip Replacement?

Yes, hip preservation surgery can help you avoid or delay hip replacement if your joint has not developed severe arthritis or irreversible damage. By correcting the underlying structural problem early, the procedure reduces ongoing stress within the joint. This helps preserve your natural hip, maintain function, and slow further joint deterioration.

Slowing joint deterioration can preserve the healthy structures your hip needs to function normally. As long as the cartilage, labrum, and surrounding thigh bone are in good condition, your natural joint can continue to support everyday movement. This is why surgeons focus on treating structural problems before permanent damage develops. Preserving these healthy tissues may help you stay active longer without needing total hip replacement surgery.

When Is It Too Late to Preserve My Hip?

Our hip preservation specialist, Dr. Nicholas Montemurro, does not recommend preservation surgery once advanced arthritis or irreversible joint damage has developed. A review in the Canadian Medical Association Journal also reports that hip preservation procedures are usually avoided in advanced hip osteoarthritis. At this stage, the cartilage has often worn away to the point where preserving the natural joint is no longer beneficial. However, our surgeon will evaluate the extent of the damage to determine whether hip replacement is the more effective long-term solution.

What Is the Difference Between Hip Preservation and Replacement?

Hip preservation surgery repairs your natural hip joint, while hip replacement removes the damaged joint and replaces it with an artificial implant. Whenever possible, surgeons prefer preserving the natural joint because it maintains your own thigh bone and soft tissues. However, the decision between these procedures depends primarily on the condition of your joint, not simply the severity of your symptoms.

Why Does My Hip Still Hurt After Rest?

Your hip may still hurt after rest because the condition affecting your hip continues to interfere with normal joint function. Although resting reduces the forces placed on the joint, it cannot correct conditions such as femoroacetabular impingement (FAI), hip dysplasia, or a labral tear. As soon as you return to your normal activities, those structural abnormalities can trigger recurring symptoms.

Here are the most common warning signs that need immediate orthopedic evaluation:

• Recurring pain that returns shortly after activity resumes.
• Progressively worsening symptoms despite appropriate conservative care.
• Pain accompanied by clicking, catching, locking, or a reduced range of motion.
• Hip discomfort that begins to interfere with routine daily activities.
• Increasing difficulty with bending, twisting, or rotating the hip.
• Pain that interrupts sleep or continues even during periods of inactivity.

Is Hip Pain While Moving a Sign of Joint Damage?

Yes, hip pain while moving can be a sign of joint damage, particularly if it results from a structural hip condition. As the hip moves, damaged cartilage, a torn labrum, or abnormal bone contact can place stress on the joint and trigger pain. Because several painful hip conditions produce similar symptoms, an accurate diagnosis is essential to identify the exact cause and guide appropriate treatment.

What We Hear From Patients Before Their Diagnosis

At our clinic, many patients tell us they assumed the pain would eventually go away because it improved after a few days of rest. Others believed they had simply overworked the joint or that the discomfort was a normal part of staying active or getting older. Another common misconception we hear is, “If I can still get through the day, it can’t be that serious.”

However, many structural hip conditions progress gradually, allowing people to adapt without realizing how much their movement has changed. Therefore, if you notice that your hip pain keeps returning or you have gradually changed the way you walk, exercise, or perform everyday activities, schedule an evaluation at Total Orthopedic & Sports Medicine. Our hip specialist, Dr. Nicholas Montemurro, will perform a comprehensive assessment to identify the underlying cause of your symptoms and recommend the most appropriate treatment.

Is Hip Preservation Still Possible With Early Arthritis?

Yes, hip preservation may still be possible if arthritis is in its early stages and the joint has not sustained irreversible damage. Treating the underlying structural problem at this stage may help slow further joint deterioration and restore hip function. However, the amount of healthy cartilage remaining plays an important role in determining whether the natural hip can still be preserved.

In addition, the location of cartilage damage also helps surgeons assess the remaining health of the joint. For example, cartilage loss confined to a small area may still leave enough healthy joint surface to support hip preservation. In contrast, damage that extends across larger portions of the hip socket and femoral head significantly reduces the joint’s ability to function normally. This pattern of cartilage wear helps surgeons determine whether preserving the natural joint can provide lasting benefit.

What Are Your Options for Hip Preservation Surgery?

Hip arthroscopy, periacetabular osteotomy (PAO), femoral osteotomy, cartilage restoration procedures, and surgical hip dislocation are the primary hip preservation surgery options. Each procedure is performed to address a different structural abnormality within the hip. Here’s how surgeons decide which hip preservation procedure is most appropriate for your condition:

Hip Arthroscopy

Hip arthroscopy is commonly recommended for conditions such as femoroacetabular impingement (FAI), labral tears, and other problems located inside the hip joint. These conditions often cause abnormal contact between the bones or damage to the labrum during movement. Through small incisions, surgeons can reshape abnormal bone, repair the torn labrum, or remove damaged tissue without opening the joint extensively. In fact, a recent analysis reports that hip arthroscopy (a minimally invasive procedure) may help slow osteoarthritis progression in femoroacetabular impingement patients.

Periacetabular Osteotomy (PAO)

Periacetabular osteotomy (PAO) is primarily recommended for patients with hip dysplasia caused by a shallow hip socket. Rather than treating the cartilage itself, the procedure repositions the hip socket to provide better coverage of the femoral head. Improving that coverage helps distribute forces more evenly across the joint during everyday activities. This can reduce the excessive stress that contributes to continued cartilage wear over time. A large meta-analysis reports that periacetabular osteotomy can preserve the native hip in many patients for more than a decade, with survival rates approaching 68% at 20 years.

Femoral Osteotomy

In some patients, the hip socket is not the primary problem. Instead, an abnormal shape or alignment of the femur can disrupt normal joint mechanics and place excessive stress on the hip. A femoral osteotomy restores that alignment so the ball and socket function together more naturally. Restoring normal alignment can also reduce abnormal joint loading during walking, bending, and other daily activities. This procedure is typically reserved for carefully selected structural deformities that cannot be corrected with arthroscopy alone.

Cartilage Restoration

Cartilage restoration procedures are considered when cartilage damage is limited to specific areas of the joint rather than being widespread. Because healthy cartilage remains in the surrounding joint, restoring the damaged area may help preserve overall joint function. However, these procedures are generally not recommended once extensive cartilage loss has developed throughout the hip. Surgeons also evaluate the size and location of the defect, along with the condition of the surrounding cartilage, to determine whether restoration can offer long-term benefit.

Surgical Hip Dislocation

Surgical hip dislocation is reserved for complex hip abnormalities that cannot be fully addressed through arthroscopy alone. In these cases, complete access to the joint is necessary to accurately evaluate and correct the underlying structural problem. This approach provides complete access to the hip joint while preserving its blood supply, allowing surgeons to accurately correct complex structural abnormalities. A hip preservation review also reports that controlled surgical dislocation allows comprehensive correction of deformities.

At Total Orthopedic & Sports Medicine, our hip specialist, Dr. Nicholas Montemurro, focuses on correcting the structural abnormality responsible for your hip dysfunction rather than simply treating its effects. Every procedure is selected to restore joint mechanics while preserving healthy anatomy whenever possible. Call 855-321-6784 today to discuss the treatment options available for your condition.

What Results Can You Expect After Surgery?

Most patients experience significant pain reduction, improved hip function, and a gradual return to normal activities after hip preservation surgery. As healing progresses, strength and range of motion continue to improve. Correcting the underlying structural problem also helps reduce the abnormal forces that contribute to continued joint damage.

Here’s how Dr. Nicholas Montemurro evaluates whether your hip is recovering as expected:

• Restoration of hip range of motion without recurrent impingement or mechanical symptoms.
• The hip joint remains stable during movement, allowing surrounding muscles to function more efficiently.
• Strength and movement gradually improve, reducing excess stress on the pelvis, lower back, and opposite hip.
• You regain the ability to perform daily activities and sport-specific movements without persistent pain or mechanical symptoms.
• Follow-up examinations confirm that the corrected joint mechanics are supporting a stable recovery as healing progresses.

What Is the Recovery Time for Hip Preservation Surgery?

Based on our experience, recovery after hip preservation surgery typically takes 4 to 6 months, although full recovery may take up to a year, depending on the procedure performed. A national registry study also reports that most patients improve significantly by 6 months after hip preservation surgery. The early weeks focus on protecting the hip while restoring mobility through rehabilitation. As healing progresses, strengthening exercises and a gradual return to higher-level activities help restore function.

In addition, some patients may require temporary walking support during the early stages of recovery to protect the healing hip. For example, most patients use crutches for approximately 2 to 3 weeks after hip arthroscopy and about 6 weeks after a periacetabular osteotomy, although these timelines may vary based on individual healing. With appropriate rehabilitation guidelines and recommended assistive devices, you can resume limited activities within 4 to 6 weeks, while full recovery continues over the following months.

Can Untreated Femoroacetabular Impingement Damage the Joint?

Yes, untreated femoroacetabular impingement (FAI) can progressively damage the hip joint over time. Repeated abnormal contact between the ball and socket can injure the labrum and wear down the joint cartilage with everyday movement. Without addressing the underlying impingement, this ongoing damage may increase the risk of developing early hip arthritis.

Here are some other risks associated with delaying treatment for femoroacetabular impingement (FAI):

• Progressive loss of hip range of motion, making everyday movements more difficult.
• Persistent hip pain that may become more frequent or severe with activity.
• More extensive joint damage, which can limit hip preservation options in the future.
• Reduced ability to participate in sports and other physical activities because of worsening symptoms.

When Should You Get a Second Opinion for Hip Surgery?

You should get a second opinion for hip surgery if you’re uncertain about your diagnosis, recommended procedure, or treatment plan. Another evaluation can confirm whether surgery is necessary or help identify alternative treatment options. It also helps ensure that the recommended surgical approach aligns with your diagnosis and long-term functional goals.

Visit Total Orthopedics & Sports Medicine to Find out If You Qualify for Hip Preservation Surgery!

Hip pain can make it difficult to stay active, perform daily tasks, or continue the sports and activities you enjoy. If conservative treatments have not relieved your symptoms, the underlying structural problem may continue to damage your hip joint. Without proper evaluation, that damage can progress over time, making it more difficult to preserve your natural hip.

At Total Orthopedic & Sports Medicine, Dr. Nicholas Montemurro identifies the structural cause of your hip pain through a comprehensive evaluation. He correlates your symptoms with your physical examination and imaging findings to determine whether hip preservation surgery can address the underlying problem. Call 855-321-6784 or visit 5500 S Merrick Rd, Massapequa, NY 11758 to determine your surgical candidacy.

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