Hip preservation surgery vs. Total hip replacement
Hip preservation surgery has been a remarkable advance for young adults with early stages of arthritis from hip dysplasia. The surgical techniques for periacetabular osteotomy (PAO) [http://hipdysplasia.org/news/scientific-literature-reviews/periacetabular-osteotomy-what-determines-success-or-failure/] continue to improve, and a recent report shows that even the first patients were highly successful. In that report the first seventy-five PAO procedures ever performed were reviewed after at least thirty years. While many had eventually required total hip replacement, almost one in three was still going strong without any additional surgery. [https://www.ncbi.nlm.nih.gov/pubmed/27905061] The long-term results of PAO surgery should be even better today because of improved techniques and because doctors are better able to identify the patients who are most likely to benefit.
When hip arthritis is too severe for hip preservation surgery, then total hip replacement is usually the best choice. Hip dysplasia is the most common cause of hip arthritis in women younger than fifty, and hip dysplasia is the cause of 5% to10% of all total hip replacements. Approximately one in four older adults will develop hip arthritis and one in ten will need a total hip replacement. The good news is that total hip replacement is highly successful even though it’s better to have your natural hip joint instead of an artificial hip joint. A recent report of 63,000 older total hip replacements concluded that lifetime risk of repeat surgery is slightly higher than previously reported, especially for patients younger than fifty years. [https://www.ncbi.nlm.nih.gov/pubmed/28209371].However, the risk of more surgery is still fairly low. Women undergoing hip replacement between ages 50 and 55 have a lifetime risk of revision surgery of approximately 20%. In the same age group men have a 35% lifetime risk of hip joint revision surgery. The lifetime risk for those younger than 50 years isn’t known exactly, but it’s probably greater than the 50-55-year age group. Joint replacement techniques in younger patients continue to improve, so that’s a good choice when hip preservation surgery is not possible, but there is definitely a place to preserve the natural hip when that’s possible.