Hip conserving surgery
Hip conservative surgery aims to restore functionality and relieve pain in patients whose hip joint has been damaged by repeated diseases, injuries, or degenerative conditions by maintaining the native joint but correcting architectural defects. It is differentiated from prosthetic surgery, which replaces the joint. This includes several key types of procedures, including surgeries related to hip dysplasia, femoroacetabular impingement, and the correction of bone disorders.
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PR Nicolas Reina
Head of the Hip and Traumatology Department
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Professor Nicolas Reina
Degenerative pathology and osteoarthritis
Traumatic pathology
Athlete pathology
Hip replacement surgery is a complex procedure to replace or repair an existing hip replacement that has failed or deteriorated over time.
Hip Dysplasia Surgery
Hip dysplasia is a congenital malformation that compromises the correct joint between the femoral head and the acetabulum. Surgical treatment may include procedures such as abutment, periacetabular osteotomy, and femoral osteotomy, each with specific indications and goals.
Acetabular abutment
Acetabular abutment is a procedure designed to improve hip stability by increasing bone support around the femoral head. Using a bone graft, this technique aims to rebuild or strengthen the acetabulum. The stop makes it possible to correct deformations and promote better contact between the femoral head and the acetabulum, thus reducing pain and the risk of osteoarthritis.
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Periacetabular osteotomy
Periacetabular osteotomy, on the other hand, consists in cutting and repositioning the pelvis in order to optimize the alignment of the acetabulum. This intervention is mainly aimed at young patients suffering from hip dysplasia. It creates a more stable bore for the femoral head, thus improving joint function. This procedure is often recommended to prevent the early onset of osteoarthritis.
Femoral osteotomy
Femoral osteotomy is another option that may be considered in cases of dysplasia. This intervention consists in sectioning the femur to realign it, thus allowing a more balanced distribution of forces across the hip. It is often indicated when dysplasia causes deformity in the femur itself, contributing to pain or impaired function.
Other bone disorders, such as acetabulum or femur malformations, may require osteotomies to correct alignment. These interventions not only relieve pain, but also prolong the life of the joint, avoiding the early use of arthroplasty.
Femoroacetabular Conflict Surgery
Femoroacetabular impingement (CFA or FAI) is a condition where there is mechanical interference between the femoral head and the acetabulum. Two types of conflicts are often identified: conflict by cam effect and conflict by pinch effect.
Conflict by Came Effect
Cam impingement occurs when the shape of the femoral head is changed, often due to malformation or exostosis, resulting in a “cam” movement during hip flexures. This conflict causes pain during activities and can damage the cartilage in the acetabulum. Surgery may include unbridling the joint to remove bone growths, thus promoting harmonious joint movement.
Conflict by Plier Effect
Pinch conflict, on the other hand, occurs when the acetabulum is too exponential or the femoral head is too large. During flexure and adduction movements, the protruding part of the femoral head comes into contact with the edge of the acetabulum, creating a “clamp” phenomenon. This can lead to severe pain and deterioration of articular cartilage. Surgical management may include arthroscopy to correct these interferences and preserve joint function.
Labrum repair
A lesion of the labrum, which is a fibrocartilaginous structure surrounding the acetabulum, may occur in this context. Repairing it is an arthroscopic procedure used to treat labrum tears. Labrum tears can cause pain and joint instability. Repair consists in suturing or unbridging the damaged parts.
Other procedures
There are numerous other conservative interventions. Their objective is to treat specific pain or to avoid a degenerative evolution of the joint.
Among them, some are performed under arthroscopy. Tenotomies (tendon section) of the psoas, on the other hand, make it possible to treat pain and movement limitations due to a contracture or inflammation of this muscle. This intervention aims to release the tension associated with injuries to this tendon or a conflict with a bone structure or a hip prosthesis cup.
Other tenotomies at the level of the adductors exist in the context of the treatment of pubalgia for example. They can be done by surgical procedure.