Surgical Management of Hip Pain in Active Patients With Early Osteoarthritis: Navigating the Choice Between Hip Preservation and Arthroplasty
Author(s): McCarroll TR, Kuhns BD, Domb BG
DOI: 10.5435/JAAOS-D-24-00242
Background
Managing hip pain in young, active individuals with early osteoarthritis (OA) presents a clinical dilemma. Physicians must balance the desire to preserve the natural joint with concerns over the long-term performance of hip arthroplasty in this high-demand population.
Methods
This review outlines a spectrum of treatment options ranging from conservative management to arthroscopic and open hip preservation techniques, hip resurfacing, and total hip arthroplasty. The emphasis is on tailoring intervention strategies to the individual patient.
Key Findings
- Treatment selection should be based on patient activity level, degree of joint degeneration, and long-term expectations.
- Hip arthroscopy or open preservation procedures are preferred when cartilage damage is minimal.
- Hip resurfacing and arthroplasty are suitable for patients with more advanced disease or higher functional demands, but implant longevity remains a key consideration.
Conclusion
A personalized, patient-specific strategy is critical in determining the optimal surgical approach. Neither hip preservation nor arthroplasty is universally superior—decisions must be made in the context of individual clinical and lifestyle factors.
What Does This Mean for Providers?
For orthopedic and sports medicine providers, this article underscores the importance of a nuanced approach to young, active patients with early OA. When preservation is feasible, arthroscopy or open techniques may delay the need for arthroplasty. However, in select cases—especially those involving significant structural compromise or high functional expectations—early arthroplasty or resurfacing may offer a more predictable outcome. Thorough preoperative assessment, shared decision-making, and managing patient expectations are crucial for optimal outcomes.