Decision Making in Borderline Cases between Hip Preservation and Reconstruction Surgery

Abstract

The hip joint is the center of human body movement. An optimal hip function is critical for general health, mental health and well-being. A frequent dilemma in orthopedic practice is what to recommend to a patient with hip pain who is neither the ideal candidate for hip preservation surgery nor for total hip arthroplasty. What are the factors to be considered when deciding between a hip preservation or replacement surgery? This chapter aims to help orthopedic surgeons to decide between hip preservation or total hip arthroplasty as the primary surgery for borderline cases. Chondral damage, age, acetabular dysplasia, femoral torsion abnormality, lumbar spine disease, patient expectation, abnormalities in more than one hip layer, comorbidities, and psycho-social determinants are the main factors to be considered on decision-making for hip surgery. Conservative management, hip arthroscopy, hip osteotomy, and total hip arthroplasty can also be seen as a continuum of treatment.