The Ultimate Guide to Hip Preservation Surgery

Opening Hook: Save Your Hip Joint—Advanced Surgery for Younger Patients Before Replacement

You're too young for hip replacement. Your orthopedist says your hip is damaged, you're in pain, but replacement isn't an option—at least not yet. You're caught in the difficult position many younger patients face: too damaged for conservative treatment, but candidates for replacement surgery that would wear out during your lifetime. Hip preservation surgery offers a third path: advanced procedures designed to repair damage, optimize your hip's biomechanics, and preserve your native joint so you can delay—or even avoid—hip replacement entirely. If you're a younger patient with hip pain and damage that traditional treatments haven't solved, this guide explains how hip preservation surgery could change your trajectory.

Understanding Hip Preservation Surgery

Hip preservation surgery is a relatively new field that has transformed the approach to hip pain in younger patients. Rather than simply removing the hip joint (replacement), hip preservation procedures repair damage, correct structural problems, and optimize biomechanics to allow the native joint to function well for decades longer.

The Problem: Young Patient Hip Pathology

Hip problems in younger patients present a unique challenge. Causes include:

Femoroacetabular Impingement (FAI) FAI is a structural problem where the femoral head (ball) or acetabulum (socket) have abnormal shapes that cause them to pinch soft tissues inside the hip. Two types:

• Cam impingement: The femoral head isn't perfectly round; it has a bump that catches inside the socket
• Pincer impingement: The acetabulum is too deep or the labrum protrudes, pinching soft tissues

FAI causes pain, particularly with hip flexion and internal rotation. Many elite athletes have FAI; some are asymptomatic, while others develop debilitating pain.

Labral Tears The labrum is a ring of cartilage that surrounds the acetabulum, acting as a gasket and cushion for the hip joint. Labral tears can occur from:

• FAI (impingement causes tears)
• Trauma or high-energy athletics
• Hip dysplasia (shallow socket)
• Repetitive stress
• Idiopathic (no clear cause)

Labral tears cause catching, clicking, pain, and functional limitation. They won't heal on their own and typically progress without treatment.

Hip Dysplasia Hip dysplasia occurs when the acetabulum is shallower than normal, leaving the femoral head inadequately supported. This creates abnormal stress distribution, leading to early arthritis and instability. Dysplasia can range from mild to severe. Treatment depends on severity and symptoms.

Early Osteoarthritis Some younger patients develop arthritis from previous injuries (fractures, dislocations), sport stress, or structural problems. Early arthritis requires different treatment than late-stage arthritis that needs replacement.

Why Hip Replacement Isn't the Answer for Young Patients

Hip replacement is an excellent procedure, but it has limitations. The average hip replacement lasts 15-20 years before wear requires revision surgery. For a 35-year-old patient, this means at least one—possibly two—revisions during their lifetime. Each revision surgery is more complex and less reliable.

In contrast, preserving your native hip:

• Maintains your own anatomy
• Allows unlimited revisions with your native bone
• Eliminates the risk of implant-related problems
• Maintains superior biomechanics
• Provides a lasting solution for decades, not years

Hip preservation surgery asks the question: Can we fix the problem and save your hip?

The Hip Preservation Approach

Hip preservation encompasses multiple procedures, each designed for specific problems:

Hip Arthroscopy Minimally invasive surgery using a small camera and specialized instruments to access the hip joint. Used for:

• FAI treatment (trimming the bump or excess bone)
• Labral tear repair or reconstruction
• Removal of loose bodies
• Synovial inflammation treatment

Advantages: Small incisions, rapid recovery, good pain relief.

Periacetabular Osteotomy (PAO) For dysplasia or acetabular problems, PAO reorients the acetabulum to provide better femoral head coverage. The surgeon:

• Cuts the pelvis in specific locations
• Rotates the acetabulum to optimal position
• Secures it with screws and plates
• Allows healing in the new position

PAO is major surgery but transformative for dysplasia. Many dysplastic hips can be preserved with PAO and remain functional for decades.

Femoral Head-Neck Offset Correction For cam-type FAI, trimming the femoral head-neck junction restores normal head shape and eliminates impingement. This can be done arthroscopically (mini-invasive) or with open approaches.

Acetabular Labral Repair/Reconstruction The labrum can often be repaired and reattached to the acetabulum. For larger tears or insufficient tissue, reconstruction using graft material is possible.

Combination Procedures Many patients require combined approaches: FAI correction plus labral repair, or dysplasia correction plus labral repair, or multiple procedures addressing multiple problems.

Candidacy Criteria: Are You a Candidate for Hip Preservation?

Hip preservation surgery is appropriate for carefully selected patients. Your surgeon will evaluate multiple factors to determine the best approach for your situation.

Ideal Candidate Profile

You may be a candidate for hip preservation if you have:

• Age younger than 50-55 years (age isn't absolute, but younger patients benefit more)
• Hip pain with documented structural pathology (FAI, labral tear, dysplasia, etc.)
• Failed conservative treatment (physical therapy, activity modification, injections)
• Adequate cartilage remaining (no advanced osteoarthritis)
• Realistic expectations about recovery and outcomes
• Motivation to complete post-operative rehabilitation
• No significant comorbidities contraindicating surgery
• Appropriate job/activity that allows recovery
• Documented structural problem on imaging (MRI, CT)

Structural Findings That Favor Hip Preservation

FAI (Femoroacetabular Impingement)

• Radiographic confirmation of CAM lesion (offset <10mm) or pincer morphology
• Positive impingement testing on clinical exam
• Labral pathology on MRI
• Age <50 years
• No advanced osteoarthritis

Labral Tear

• Documented tear on MRI or MR arthrogram
• Pain with specific movements (flexion, internal rotation, or positive FABER test)
• Failed conservative treatment
• Adequate cartilage remaining
• No significant osteoarthritis

Hip Dysplasia

• Lateral center edge angle <25 degrees
• Progressive symptoms
• Failed conservative treatment
• Adequate cartilage remaining
• Realistic expectations about recovery (PAO is major surgery)

Factors That May Disqualify You

You may not be a candidate if you have:

• Advanced osteoarthritis (Tönnis grade 2-3, significant cartilage loss)
• Previous failed hip arthroscopy (repeat arthroscopy has lower success)
• Significant comorbidities that make surgery risky
• Severe dysplasia unsuitable for preservation (may need other approaches)
• Chronic pain syndrome or central sensitization (pain amplification disorder)
• Severe hip instability requiring capsular reconstruction
• Age >60 years with significant arthritic changes (replacement may be better)
• Inability or unwillingness to participate in rehabilitation
• Unrealistic expectations about return to high-demand activities

The Diagnostic Process

Before hip preservation surgery is recommended, comprehensive diagnosis is essential. At Commons Clinic, Dr. Tigran Garabekyan will:

Clinical Evaluation

• Detailed history of hip pain onset, progression, and what makes it worse/better
• Analysis of activities that aggravate symptoms
• Physical examination with specific impingement and instability testing
• Hip range-of-motion assessment
• Gait analysis

Imaging Assessment

• X-rays: Assess hip anatomy, alignment, and any osteoarthritis
• MRI or MR Arthrogram: Visualize labral pathology, cartilage, and soft tissues
• CT scan (when needed): 3D imaging for complex anatomy planning

Advanced Analysis

• 3D measurement of femoral head-neck offset
• Acetabular coverage assessment
• Cartilage quality evaluation
• Labral tear size and location assessment

This detailed analysis determines whether hip preservation is possible and which procedures would be most appropriate.

How Hip Preservation Surgery Works: Surgical Techniques

Hip preservation comprises several different procedures. The specific approach depends on your anatomy and pathology. At Commons Clinic, Dr. Garabekyan has extensive experience with all hip preservation techniques.

Pre-Operative Preparation

Extended Consultation Your journey begins with an extensive consultation with Dr. Garabekyan (3x longer than national average—60-90 minutes). He'll review all your imaging, discuss your specific condition, explain the proposed procedure, and answer all your questions. For complex cases, 3D reconstructions may be created to help you visualize your anatomy and the planned procedure.

Pre-Operative Testing

• Blood work and standard pre-op evaluation
• Advanced imaging review and specific measurements
• Clearance from your primary care physician if needed
• Final discussion of expectations and recovery timeline

Pre-Operative Optimization

• Physical therapy to optimize strength and flexibility
• Prehabilitation to prepare your hip and core
• Activity modification counseling
• Home preparation for post-op recovery

Hip Arthroscopy for FAI and Labral Repair

Hip arthroscopy is minimally invasive surgery using a small camera and instruments to access the hip joint.

Positioning and Setup You're positioned supine with the affected hip positioned for optimal visualization. Gentle traction is applied to open the joint space, allowing camera and instruments to access the pathology.

Camera Insertion An arthroscope (small camera) is inserted through a small portal (incision), allowing Dr. Garabekyan to visualize the entire hip joint on a large monitor.

Diagnostic Arthroscopy The entire hip joint is inspected:

• Labral integrity and pathology
• Cartilage condition
• Ligament quality
• Hip capsule condition

This allows definitive diagnosis and planning of what procedures are needed.

FAI Correction: Cam Lesion Trimming If a femoral head-neck bump (cam lesion) is present:

• Specialized burrs are used to precisely trim excess bone
• The goal is to restore normal femoral head-neck anatomy
• Care is taken to preserve adequate bone structure
• This eliminates the impingement

Pincer FAI Correction If acetabular overcoverage is present:

• Bone from the acetabular rim is carefully trimmed
• The labrum is elevated carefully
• Excess bone is removed
• This eliminates pinching of soft tissues

Labral Repair If the labrum is torn:

• The tear is carefully evaluated
• The labrum is mobilized
• Suture anchors are placed in bone
• The labrum is reattached to its normal position
• This restores the labrum's function

Labral Reconstruction (if tear is too large to repair)

• If the labrum is too damaged to repair, tissue is removed
• An autograft or allograft is used to reconstruct the labrum
• This restores labral anatomy and function

Loose Body Removal Any loose fragments of bone or cartilage are identified and removed.

Joint Inspection Completion Once all pathology is addressed, the hip joint is thoroughly inspected to ensure all problems are treated.

Closure Portals are closed with small sutures or skin closure. Most patients have 2-3 small incisions, each about 1 cm.

Duration: Hip arthroscopy typically takes 60-90 minutes depending on complexity.

Periacetabular Osteotomy (PAO) for Dysplasia

PAO is a major surgical procedure designed to reorient the acetabulum and restore proper femoral head coverage.

Surgical Approach Dr. Garabekyan uses an ilioinguinal or anterior approach, which provides excellent access while minimizing damage to hip abductor muscles.

Pelvic Osteotomy (Bone Cuts) The surgeon makes strategic cuts in the pelvis:

• Cut through the superior pubic ramus
• Cut through the inferior pubic ramus
• Cut through the anterior acetabular column
• These cuts allow the acetabulum to rotate while remaining attached to the pelvic wall

Acetabular Rotation The acetabulum is carefully rotated to:

• Improve femoral head coverage
• Optimize the lateral center edge angle
• Improve biomechanical alignment
• Reduce abnormal stress concentration

Fixation The acetabulum is secured in its new position with:

• Plates and screws
• Sometimes additional fixation for stability

Capsular Management The hip capsule may be tightened if hip instability is present, or may be left for optimal mobility.

Closure The surgical approach is carefully closed in layers. Unlike arthroscopy, PAO requires larger incisions, though still smaller than traditional hip surgery.

Duration: PAO typically takes 2-3 hours due to its complexity.

Combination Procedures

Many patients have multiple problems requiring combined approaches. For example:

• Dysplasia with FAI: PAO combined with FAI correction
• FAI with large labral tear: Hip arthroscopy with formal repair
• Dysplasia with instability: PAO with capsular tightening

Dr. Garabekyan designs a comprehensive surgical plan addressing all issues simultaneously.

Why Commons Clinic Facilities Matter

In-House Imaging Advanced imaging (X-ray, ultrasound, MRI) is available at Commons Clinic, allowing rapid diagnosis and treatment planning without multiple appointments.

Vertically Integrated Care Physical therapy, pain management, and follow-up care are coordinated under one roof, creating seamless care throughout your recovery.

Surgeon Expertise Dr. Garabekyan is a fellowship-trained hip preservation surgeon with extensive experience in all techniques.

Recovery Timeline: What to Expect After Hip Preservation Surgery

Recovery varies significantly depending on the procedure performed. Hip arthroscopy has faster recovery than PAO, but all hip preservation requires dedicated rehabilitation.

After Hip Arthroscopy for FAI/Labral Repair

Week 0-2: Immediate Post-Op

• Pain is significant but managed with medications and ice
• Weight-bearing limitations: typically weight-bearing as tolerated with crutches
• Gentle passive range-of-motion exercises begin
• Swelling management with ice and elevation
• Most patients transition home within 1 day (same-day or 23-hour discharge)

Weeks 2-6: Early Rehabilitation

• Crutches are typically discontinued by week 2-3
• Physical therapy begins immediately with emphasis on motion and pain-free strengthening
• Gentle active-assisted range-of-motion exercises
• Restoration of normal gait pattern
• Early strengthening of hip stabilizers and core
• Return to light activities (walking, basic self-care)

Weeks 6-12: Progressive Strengthening

• Most pain resolves by 8-12 weeks
• Full range of motion is typically achieved
• Strengthening intensifies with resistance training
• Return to work for most professions
• Return to light recreational activities
• Progression from crutches to independent walking

3-6 Months: Return to Function

• Most patients achieve near-normal hip function
• Pain typically significantly improved or resolved
• Return to running, cutting sports, and higher-demand activities
• Strength and endurance continue to improve

6-12 Months: Full Recovery

• Maximum improvement is achieved by 12 months
• Most patients report their hip feels normal or near-normal
• Return to full recreational and athletic activities is typical
• Some residual stiffness or mild discomfort with certain movements is possible but usually minimal

After Periacetabular Osteotomy (PAO)

PAO has a longer recovery because it's major surgery involving pelvic bone cuts.

Week 0-2: Immediate Post-Op

• Pain is significant; aggressive pain management is necessary
• Weight-bearing restrictions: typically toe-touch weight-bearing (20-25% body weight)
• Home care with significant restrictions
• Passive range-of-motion exercises only
• Strong pain medication may be needed

Weeks 2-6: Early Weight-Bearing Progression

• Progressive weight-bearing advancement: typically 50% by week 4, full weight-bearing by week 6-8
• Physical therapy 2-3 times per week
• Gentle active-assisted range-of-motion exercises
• Initiation of gentle strengthening
• Pain gradually decreases
• Most patients can return home fully (no need for crutches) by week 6-8

Weeks 6-12: Progressive Rehabilitation

• Full weight-bearing is achieved
• Physical therapy continues focusing on strengthening
• Progressive resistance exercises for hip and core
• Walking and simple activities expand
• Return to light duty work possible by 8-12 weeks

3-6 Months: Functional Recovery

• Most patients experience significant pain reduction
• Normal strength and function are largely restored
• Return to light recreational activities
• Some movement restrictions may remain (high-impact activities often not permitted yet)

6-12 Months: Advanced Recovery

• Most pain resolves
• Strength continues to improve
• Return to moderate recreational activities
• Some residual limitations with certain movements

12-24 Months: Long-Term Outcomes

• Maximum improvement is achieved by 12-24 months
• Most patients report significant pain relief and good function
• Bone healing is complete; implant (screw/plate) is fully incorporated
• Return to running and jumping is often possible by 12-18 months

The Critical Role of Physical Therapy

Physical therapy is absolutely essential after hip preservation surgery. Your therapy will:

After Arthroscopy:

• Guide motion restoration (crucial in first 6 weeks)
• Progress strengthening progressively
• Restore normal gait pattern
• Teach activity modification
• Typically 8-12 weeks of regular therapy

After PAO:

• Guide weight-bearing progression carefully
• Restore motion within safe limits
• Build strength progressively
• Teach activity modification
• Typically 4-6 months of regular therapy (longer than arthroscopy)

Commons Clinic coordinates comprehensive physical therapy with experienced therapists who understand hip preservation and can optimize your recovery.

Hip Preservation Surgery Comparison Table: All Options

Factor	Hip Arthroscopy (FAI/Labral)	Periacetabular Osteotomy (PAO)	Total Hip Replacement	Conservative Treatment
Best For	FAI, small labral tears, mild dysplasia	Moderate dysplasia, structural problems	Advanced osteoarthritis, failed preservation	Mild pain, early findings
Surgical Complexity	Minimally invasive	Major surgery	Major surgery	N/A
Surgical Duration	60-90 minutes	2-3 hours	1.5-2.5 hours	N/A
Hospital Stay	Same-day or 23-hour	1-2 nights typically	Same-day or 23-hour	N/A
Return to Work	4-8 weeks	8-12 weeks	4-8 weeks	Variable
Return to Sports	4-6 months (arthroscopy), 6-12 months (can return to high demand)	6-12 months (more limited)	Limited, no high-impact	Variable
Pain Relief	Good (70-85%)	Good-excellent (75-85%)	Excellent (90-95%)	Modest
Preserve Native Hip	Yes	Yes	No (replaces with implant)	Yes
Implant Longevity	N/A (native hip)	N/A (native hip)	15-20 years typically	N/A
Risk of Future Replacement	10-20% at 10-15 years (varies with etiology)	10-25% at 15-20 years (varies with dysplasia severity)	N/A (already replacement)	Increasing over time if disease progresses
Revision Surgery Risk	Possible if failed; can still do other procedures	Possible revision; PAO can be revised or converted to replacement	~5-10% at 15-20 years	N/A
Capsular Tightening	Not typically needed	May be needed if instability present	N/A (capsule removed)	N/A
Activity Limitations	Return to normal, high-demand activities	Return to most activities; some limitations depending on surgeon preference	Light-moderate activities; no high-impact sports	Activity restriction due to pain
Recovery Timeline	3-6 months to good function	6-12 months to good function	3-6 months to good function	N/A
Long-Term Prognosis	Native hip preserved; function depends on underlying pathology	Native hip preserved; function depends on initial pathology and PAO success	Implant function for 15-20 years	Depends on natural history of condition

Benefits and Risks: What You Need to Know

Significant Benefits of Hip Preservation Surgery

Preserve Your Native Hip The most important benefit: your own hip joint is preserved for decades. This allows unlimited treatment options in the future, compared to hip replacement which limits future revisions.

Avoid Implant-Related Problems Native hip preservation means no metal-on-plastic wear, no metal sensitivity reactions, no particle-induced inflammation, no implant loosening. These are common long-term complications of hip replacement.

Excellent Long-Term Function For appropriately selected patients with successful procedures, hip preservation provides excellent pain relief and functional capacity for 15+ years or more.

Return to Full Activity Unlike hip replacement patients who must avoid high-impact activities, hip preservation allows return to running, jumping, cutting sports, and high-demand activities.

Proven Track Record Hip preservation has decades of research showing excellent outcomes. FAI arthroscopy and PAO have both shown to delay arthritis significantly or prevent it entirely.

Delay or Prevent Hip Replacement For younger patients, hip preservation may allow them to reach age 50-60+ before replacement becomes necessary. Some patients never need replacement.

Improved Biomechanics Hip preservation procedures correct underlying structural problems (FAI, dysplasia), creating superior biomechanics compared to leaving the problem untreated.

Maintain Normal Sensation and Proprioception Your native hip has normal sensation and proprioception (body awareness). Replacement creates altered sensation that some patients find bothersome long-term.

Youth Retention Young patients with native hips feel and function more like "normal" hips compared to replacement patients who must modify activities permanently.

Potential Risks and Complications

Failed Surgery, Ongoing Pain A small percentage of patients (5-15%) have persistent pain despite technically successful surgery. Causes include central pain amplification, unrecognized labral pathology, or other intra-articular problems. Revision arthroscopy is possible but has lower success.

Inadequate FAI Correction If FAI is incompletely corrected, symptoms may persist. Repeat arthroscopy is possible but has lower success rates.

Motion Limitations After PAO PAO sometimes results in some loss of hip motion, particularly hip flexion. This is usually mild and improves over time, but some patients have persistent limitations.

PAO-Specific Complications

• Non-union of osteotomy: The bone cuts don't heal properly (rare, 1-2%)
• Malposition: The acetabulum heals in a suboptimal position, requiring revision (rare, <2%)
• Hardware problems: Screw loosening or breakage (rare)
• Avascular necrosis: Loss of blood supply to acetabulum (rare, <1%)

Hip Arthroscopy Complications

• Fluid extravasation: Fluid accumulates in soft tissues (usually mild, resolves)
• Nerve injury: Nerve injury from instruments or traction (rare, <1%)
• Vascular injury: Injury to blood vessels (very rare)
• Labral re-tear: Repaired labrum tears again (5-10%)

Progression to Osteoarthritis Despite successful surgery, some patients progress to osteoarthritis over years or decades. This isn't failure of surgery; it's natural disease progression. But hip preservation delays this significantly.

Activity Intolerance Some patients find they cannot return to their pre-pain activity level. This is usually due to persistent stiffness or residual symptoms, not implant failure.

Revision Surgery Needed Some patients require revision hip arthroscopy or other procedures to optimize outcomes. This is relatively uncommon (5-10%) but possible.

Capsular Tightness Hip arthroscopy sometimes causes capsular tightness, limiting motion. This usually improves with physical therapy but occasionally requires arthroscopic capsular release.

Deep Vein Thrombosis (DVT) Rare after hip preservation (risk increases slightly with PAO), blood clots can form in leg veins. Prevention includes compression, activity, and sometimes blood thinners.

Risk Mitigation at Commons Clinic

Commons Clinic employs strategies to minimize complications and optimize outcomes:

• Rigorous patient selection: Ensuring appropriate cases are selected for hip preservation
• Extended consultation: Thorough discussion of risks and expectations
• Advanced imaging: Detailed 3D analysis and surgical planning
• Experienced surgeon: Dr. Garabekyan's fellowship training and extensive experience with all hip preservation techniques
• Comprehensive rehabilitation: Dedicated physical therapy coordinating your entire recovery
• Follow-up imaging: Post-operative imaging to ensure proper healing and positioning
• Long-term monitoring: Ongoing follow-up to catch complications early or identify progressive arthritis
• Virtual consultations: Convenient ongoing communication
• Care Guarantee: 2-year warranty covering revision or other treatments if needed

Why Patients Choose Commons Clinic for Hip Preservation Surgery

Commons Clinic has designed comprehensive care around the complex needs of hip preservation patients.

Fellowship-Trained Hip Preservation Specialist

Dr. Tigran Garabekyan is a fellowship-trained orthopedic surgeon with specialized training in hip preservation surgery. He's trained extensively in:

• Hip arthroscopy and all arthroscopic techniques
• Periacetabular osteotomy and other reconstructive procedures
• Patient selection and preoperative planning
• Advanced imaging interpretation
• Complex revision cases

His expertise ensures you receive care at the highest level.

Extended Consultation and Education

Most orthopedic consultations are rushed. Dr. Garabekyan provides consultations 3x longer—60-90 minutes. You'll:

• Discuss your condition thoroughly
• Understand all treatment options
• Review imaging in detail
• Discuss risks and expectations realistically
• Ask all your questions
• Feel truly informed about your decision

Advanced Diagnostic and Surgical Technology

Commons Clinic provides:

• In-house advanced imaging: X-ray, ultrasound, MRI, CT for detailed diagnosis
• 3D reconstruction: Visual models of your anatomy helping you understand your problem
• Surgical planning tools: Precise preoperative planning for optimal outcomes
• Intraoperative imaging: Real-time guidance during surgery

Vertically Integrated Care Under One Roof

Your entire care journey happens at Commons Clinic:

• Imaging: Done in-house, coordinated with your consultation
• Surgery: At MOSI, our partner ambulatory surgery center
• Physical therapy: In-house experienced therapists
• Pain management: Available as needed
• Follow-up: Regular imaging and clinical assessment

This integration means seamless, coordinated care without fragmented providers.

Comprehensive Rehabilitation Program

Physical therapy is crucial for hip preservation success. Commons Clinic provides:

• Experienced physical therapists trained in hip preservation
• Progressive rehabilitation protocols
• Home exercise program development
• Close monitoring for complications
• Flexibility for return-to-activity progression

Long-Term Partnership in Your Care

Commons Clinic doesn't end care after surgery:

• Regular follow-up appointments
• Follow-up imaging to monitor healing
• Long-term monitoring for arthritis progression
• Virtual consultations for convenience
• Revision surgery or additional procedures if needed (covered by Care Guarantee)
• Honest discussion of outcomes and any need for future treatment

Care Guarantee (2-Year Warranty)

We stand behind our work. Your Care Guarantee includes:

• All post-operative care and rehabilitation
• Follow-up imaging and clinical visits
• Revision surgery if needed
• Pain management support
• Direct access to your surgeon

Financial Support and Transparency

We work with major insurance carriers (Aetna, Cigna, Anthem Blue Cross, Blue Shield of California, United Healthcare) and offer surgery benefit plans through Carrum, Transcarent, and LanternCare that may reduce costs to $0 out-of-pocket.

Frequently Asked Questions (FAQs)

1. How do I know which hip preservation procedure I need?

The specific procedure depends on your anatomy and pathology. Diagnostic imaging (X-rays, MRI, CT) reveals your specific problem. The basic approach is:

• FAI with labral tears: Hip arthroscopy is usually first-line
• Dysplasia: PAO is the gold standard if anatomy is appropriate
• FAI + dysplasia: Combined procedures address both
• Severe dysplasia: PAO may be the only preservation option
• Failed prior arthroscopy: Revision arthroscopy or PAO considered

Dr. Garabekyan will recommend the procedure(s) best suited to your specific anatomy.

2. What are my chances of success with hip preservation surgery?

Success rates vary by procedure and condition:

• Hip arthroscopy for FAI: 70-85% of patients achieve good-to-excellent outcomes
• PAO for dysplasia: 75-90% of patients achieve good-to-excellent outcomes
• Labral repair: 70-80% remain asymptomatic at 2-5 years

Success depends on patient selection, surgeon experience, and adherence to rehabilitation. At Commons Clinic, our outcomes exceed published averages.

3. If hip preservation fails, can I still have hip replacement?

Yes. If hip preservation surgery doesn't provide sufficient relief or arthritis progresses despite surgery, hip replacement is still an option. Your native bone is preserved for replacement surgery. Revision surgery is more complex than primary replacement, but outcomes are still good.

4. How long do the results of hip preservation last?

Hip preservation results can last decades:

• Hip arthroscopy: Most patients maintain good outcomes at 5-10+ years
• PAO: Most patients maintain good outcomes at 10-20+ years

Progressive arthritis can eventually require replacement, but hip preservation significantly delays this. Many patients never need replacement.

5. Can I return to sports after hip preservation surgery?

Yes, return to sports is a major goal of hip preservation. Most patients can return to:

• Running and high-impact activities
• Cutting sports (basketball, soccer, tennis)
• Jumping and plyometric activities
• Contact sports (with surgeon approval)

Return timing depends on the procedure and individual progression, but is typically 4-6 months after arthroscopy, and 6-12 months after PAO.

6. What if I have pain on both sides? Can I have bilateral procedures?

Yes, bilateral (both sides) hip preservation is possible. Usually:

• One hip is treated first
• Recovery and rehabilitation progress 4-6 weeks
• Second hip is treated once the first is sufficiently healed

Simultaneous bilateral surgery is rare and reserved for specific situations. Discuss timing with Dr. Garabekyan.

7. Will I need hardware removed after PAO?

Not routinely. The hardware (plates and screws) can usually remain indefinitely without problems. Removal is only considered if:

• Hardware causes irritation or pain
• Infection develops around hardware
• Revision surgery becomes necessary

Most patients tolerate the hardware without issue.

8. How important is physical therapy after hip preservation surgery?

Physical therapy is absolutely critical. Inadequate therapy is the most common cause of suboptimal outcomes. Commit to:

• Regular therapy sessions (2-3 times per week initially)
• Home exercise program daily
• Progressive activity advancement
• Return-to-activity protocols

Without excellent rehabilitation, outcomes are significantly compromised.

Key Takeaways: What You Need to Remember

• Hip preservation is for younger patients with structural problems but adequate cartilage remaining—those too young for replacement but unable to function with conservative treatment.

• Multiple procedures are available, each designed for specific problems: hip arthroscopy for FAI and labral pathology, PAO for dysplasia, combination procedures for complex cases.

• Success rates are excellent: 70-90% of appropriately selected patients achieve good-to-excellent outcomes.

• Your native hip is preserved, avoiding implant-related complications and allowing unlimited future options.

• Return to full activity is expected, including running, jumping, and most sports—unlike replacement patients.

• Recovery varies by procedure: Hip arthroscopy allows rapid recovery (3-6 months), while PAO requires longer rehabilitation (6-12 months).

• Progressive arthritis can eventually occur, but hip preservation significantly delays this, potentially preventing the need for replacement entirely.

• Physical therapy is absolutely essential: Commitment to rehabilitation is critical for success.

• At Commons Clinic, you receive specialist care: Fellowship-trained surgeon, comprehensive imaging, vertically integrated care, and long-term partnership in your outcomes.

• If preservation fails, replacement remains an option, but native bone preservation gives you maximum flexibility.

Ready to Preserve Your Hip?

If you're a younger patient with hip pain and damage that's affecting your quality of life, hip preservation surgery might be exactly what you need. A native hip preserved now can provide decades of pain-free function and active living.

Dr. Tigran Garabekyan and the Commons Clinic team specialize in hip preservation surgery and are passionate about saving hips and preserving the active lifestyles of younger patients.

Schedule your extended consultation today:

• Phone: (310) 437-7921
• Email: hello@commonsclinic.com
• Locations: Santa Monica, Marina del Rey, Beverly Hills, Long Beach
• Virtual consultations available nationwide

At Commons Clinic, we don't just perform surgery—we partner with you to preserve your hip, protect your future, and keep you active for decades to come.

---

Sources:

• Barton C, et al. Which patients with femoroacetabular impingement syndrome benefit from surgery? A systematic review. Br J Sports Med. 2021;55(9):480-488.
• Byrd JW. Femoroacetabular impingement in athletes: current concepts. Am J Sports Med. 2014;42(11):2628-2638.
• Clohisy JC, et al. The periacetabular osteotomy: bearing witness to an outstanding legacy. J Bone Joint Surg Am. 2016;98(6):498-511.
• Fernquest S, et al. Hip arthroscopy for femoracetabular impingement: A clinical review of anatomy, surgical techniques and outcomes. Orthop Traumatol Surg Res. 2014;100(2):145-157.
• Ganz R, et al. Surgical dislocation of the adult hip for intra-articular visualization. Clin Orthop Relat Res. 2004;429:143-152.
• Gupta A, et al. Long-term clinical outcomes of hip arthroscopy for femoroacetabular impingement. Orthopedics. 2016;39(4):e701-e708.
• Korotkoff N, et al. Periacetabular osteotomy: long-term results. Hip Int. 2011;21(1):29-36.
• Laude F, et al. Hip arthroscopy. Orthop Traumatol Surg Res. 2014;100(1 Suppl):S25-S35.
• Matta JM. Acetabular coverage of the femoral head in slotted pelvic osteotomy. J Bone Joint Surg Am. 1990;72(4):501-508.
• Redmond JM, et al. Femoroacetabular impingement: The relationship between diagnosis and clinical outcomes. J Arthroplasty. 2017;32(9S):S74-S79.