The foundation of hip preservation lies in a thorough understanding of hip biomechanics and the pathophysiological processes that contribute to joint degeneration. The hip joint’s stability is derived from the congruency between the femoral head and the acetabulum, supported by the labrum, joint capsule, and surrounding musculature. Any disruption in this intricate balance—whether due to structural abnormalities, trauma, or overuse—can lead to abnormal joint mechanics, increased contact pressures, and accelerated cartilage wear. For instance, FAI, a common cause of hip pain in young adults, occurs when there is abnormal contact between the femoral head-neck junction and the acetabular rim, leading to repetitive microtrauma, labral damage, and eventual cartilage degeneration. Similarly, hip dysplasia, characterized by insufficient acetabular coverage of the femoral head, results in uneven load distribution and early-onset osteoarthritis. Recognizing these conditions early through advanced imaging techniques such as magnetic resonance imaging (MRI), computed tomography (CT), and dynamic ultrasound is crucial for implementing timely interventions that can alter the disease trajectory.

Non-surgical management forms the first line of treatment in hip preservation and is particularly effective in early-stage conditions or for patients who are not ideal candidates for surgery. Physical therapy plays a central role in strengthening the periarticular muscles, improving joint stability, and correcting movement patterns that may exacerbate symptoms. Targeted exercises to enhance core stability, hip abductor strength, and flexibility can significantly reduce pain and improve function in patients with FAI or hip preservation  dysplasia. Additionally, activity modification to avoid high-impact sports or repetitive motions that strain the hip joint is often recommended. Pharmacological interventions, including nonsteroidal anti-inflammatory drugs (NSAIDs), may provide symptomatic relief, while intra-articular injections of corticosteroids or hyaluronic acid can offer temporary pain reduction and improved mobility for those with inflammatory or degenerative conditions. However, while these conservative measures can be effective, they are often palliative rather than curative, and surgical intervention may be necessary to address the underlying structural abnormalities.

When non-surgical treatments fail to provide adequate relief or when structural issues are severe, surgical hip preservation techniques become indispensable. These procedures aim to correct anatomical deformities, repair damaged soft tissues, and restore normal joint mechanics. Hip arthroscopy, a minimally invasive surgical technique, has revolutionized the field by allowing surgeons to address intra-articular pathologies such as labral tears, chondral defects, and FAI with smaller incisions, reduced tissue damage, and faster recovery times. During arthroscopy, the surgeon can perform labral debridement or repair, femoroplasty or acetabuloplasty to reshape bony abnormalities, and microfracture or cartilage grafting to treat focal cartilage lesions. For more complex deformities, open surgical procedures such as periacetabular osteotomy (PAO) or femoral osteotomy may be required to realign the joint and improve biomechanics. PAO, for instance, is the gold standard for treating symptomatic hip dysplasia in young adults, as it repositions the acetabulum to provide better coverage of the femoral head, thereby reducing contact pressures and delaying osteoarthritis. These surgical interventions are highly specialized and require meticulous preoperative planning, including advanced imaging and gait analysis, to ensure optimal outcomes.

The success of hip preservation strategies hinges not only on the technical precision of the interventions but also on a comprehensive, patient-centered approach that considers individual anatomy, activity levels, and long-term goals. Rehabilitation following surgical hip preservation is a critical component of recovery, involving progressive weight-bearing, neuromuscular training, and a gradual return to functional activities. Close monitoring for complications such as infection, nerve injury, or persistent pain is essential, as is patient education regarding activity modifications and joint protection strategies to prolong the lifespan of the native hip. Moreover, ongoing research into biological therapies—such as stem cell injections, platelet-rich plasma (PRP), and growth factor applications—holds promise for enhancing cartilage repair and slowing disease progression in early-stage osteoarthritis.