Hip Preservation vs. Hip Replacement: Which Is Right for Hip Pain?

If you're experiencing hip pain, hip preservation may offer an alternative to hip replacement by addressing the underlying cause of the problem and helping you keep your natural hip joint longer.

At Emory Healthcare Orthopaedics & Spine Center, surgeons use specialized techniques to diagnose and treat hip conditions that can cause pain, limit mobility and lead to early arthritis. Rather than replacing the joint, hip preservation procedures focus on repairing damaged structures and correcting underlying abnormalities that contribute to hip dysfunction.

"Our understanding of hip preservation has expanded significantly over the last two decades, allowing us to better identify underlying structural issues before they lead to arthritis and joint degeneration," says Brian Muffly, MD, orthopaedic surgeon.

As understanding of hip anatomy and biomechanics has improved, physicians can more accurately diagnose conditions that once went unrecognized, allowing patients to receive treatment before permanent joint damage occurs.

Dr. Muffly completed dual fellowships in adult hip and knee reconstruction and hip preservation surgery.

"It's uncommon for orthopaedic surgeons to complete two fellowships, and there are very few surgeons who've had a dedicated year focused solely on hip preservation," he says.

For many patients, that is the goal.

Hip preservation is designed to address structural abnormalities before they cause irreversible damage to the joint. By treating these underlying issues early, physicians may be able to reduce pain, improve mobility and help patients maintain their natural hip for years longer than they otherwise might.

"A lot of our patients are constantly thinking about their hip pain throughout their daily activities," Dr. Muffly says. "We're trying to get them thinking about their hips less and, in doing so, improve their quality of life and functionality."

While no procedure can guarantee that a patient will never need a hip replacement, hip preservation can be an effective option for people whose symptoms stem from conditions that are still treatable before significant arthritis develops.

One of the most common questions patients ask is whether they should pursue hip preservation or move forward with hip replacement surgery.

The answer depends on several factors, including the condition of the cartilage, the structure of the hip joint, activity goals and the severity of arthritis.

Patients with structural abnormalities including hip dysplasia, hip impingement, or abnormal twist to their femur (thigh) or tibia (shin) bones often benefit often benefit from preservation procedures when cartilage damage is limited. By contrast, patients with advanced arthritis or extensive joint deterioration generally achieve better outcomes with hip replacement.

A thorough evaluation by a hip specialist can help determine which approach is most appropriate.

Hip preservation is not a single procedure. Instead, it includes a collection of techniques that are tailored to a patient's specific condition.

Some patients may benefit from hip arthroscopy, a minimally invasive procedure used to treat hip impingement and repair labral tears. Others may require more complex operations such as periacetabular osteotomy (PAO) for hip dysplasia or femoral osteotomy to correct bone alignment problems.

In certain situations, surgeons may perform tendon repairs or specialized reconstructive procedures to address structural abnormalities and restore joint mechanics.

Recovery depends on the procedure performed, but physical therapy is often an important part of rehabilitation and helps patients restore strength, mobility and function.

In many cases, yes.

Most patients begin treatment with conservative approaches before surgery is considered. These may include physical therapy, activity modification, anti-inflammatory medications and image-guided injections.

Some patients also benefit from platelet-rich plasma (PRP) therapy, which uses components of a patient's own blood to support healing in certain soft tissue conditions.

"When conservative treatments don't adequately address pain and loss of function, that's when we begin discussing surgical options," Dr. Muffly says.

Persistent hip pain is never something patients should simply learn to live with.

You may benefit from a specialized hip evaluation if you experience:

• Hip or groin pain during physical activity

• Pain after prolonged sitting

• Loss of range of motion

• Clicking, catching or locking sensations within the joint

• Symptoms that continue despite physical therapy or other treatments

These symptoms do not necessarily mean surgery is required. However, they can indicate an underlying structural problem that may respond to hip preservation treatment.

Hip preservation is often most beneficial for younger and middle-aged adults who are experiencing hip pain and loss of function but have little or no arthritis.

While many candidates are teenagers, young adults and patients in their 40s, age alone is rarely the deciding factor. The overall health of the joint, the condition of the cartilage and the cause of the symptoms are often more important considerations.

The goal is to preserve a healthy natural hip whenever possible and help patients maintain active lifestyles for years to come.

Emory Healthcare offers specialized expertise for patients with complex hip conditions. Orthopaedic surgeons work closely with musculoskeletal radiologists, physical therapists and other specialists to develop individualized treatment plans.

Dr. Muffly frequently sees patients who have struggled to find answers for persistent hip pain.

"I try to help patients understand why they're having symptoms and identify treatment strategies that address the root cause of the problem," he says.

Hip preservation and hip replacement each play an important role in treating hip pain, but they are designed for different stages of joint disease.

For patients with structural abnormalities and minimal arthritis, hip preservation may offer an opportunity to reduce pain, improve function and extend the life of the natural joint. When arthritis is advanced and joint damage is significant, hip replacement may provide the most effective path to lasting relief.

The earlier hip pain is evaluated, the more treatment options may be available.

This article was originally published on April 15, 2025, and has since been updated.