Adult Reconstruction

Recent advances in imaging and surgical techniques have led to an increased awareness of pathologic conditions around the hip joint affecting active patients. Conditions, such as labral tears, femoral acetabular impingement, dysplasia, osteoarthritis, and osteonecrosis, can cause significant disability, limiting not only participation in recreational activities but also all activities of daily living. The following articles focus on the management of such pathologic conditions affecting the hip that can impact this young patient population. It will become obvious that a successful outcome in treating these patients will be dependent on an accurate diagnosis with appropriate examination and imaging in order to formulate a thoughtful approach.

Hip arthroscopy has been an evolving procedure attracting a great deal of attention with recent advances in surgical techniques, such as repair of labral tears as opposed to debridement. Joint preservation procedures are admirable and often beneficial, but anomalies of the hip joint with associated dysplasia can alter hip kinematics, leading to premature development of hip osteoarthritis. As the osteoarthritis advances, total hip arthroplasty may be indicated with the intent to relieve the pain in these young active patients with a durable and predictable prosthesis. In an effort to increase the longevity of the prosthesis, alternate bearing surfaces, such as metal on metal, metal on ceramic, and metal on highly crosslinked polyethylene, have been introduced but the advantages and disadvantages of each device must be carefully considered.

It is my expectation that the following articles will address the above-mentioned issues and provide the insight into the accurate diagnosis and selection of an appropriate treatment plan.

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