AANA25 Hip Access Pass-CONCURRENT SESSION 5F: Hip Arthroplasty

Video Transcription

Video Summary

This session highlighted advances and controversies in hip arthroplasty and hip preservation, particularly in borderline hip dysplasia and arthritis management.<br /><br />Dr. Kuhn reviewed hip arthroplasty as a transformative surgery with improved materials (ceramics, titanium), muscle-sparing approaches, and robotic assistance that enhances accuracy, bone preservation, and functional outcomes. Outpatient total hip replacement has also increased dramatically, offering quicker recovery. Hip resurfacing has reemerged, showing promise especially in athletes, when combined with navigation to reduce complications.<br /><br />Dr. Nowak presented research comparing isolated hip arthroscopy versus staged hip arthroscopy with periacetabular osteotomy (PAO) in borderline hip dysplasia. Both groups showed similarly improved short-term outcomes, low revision rates, and high survivorship. Decision-making remains nuanced, depending on factors like joint stability, activity level, and morphology.<br /><br />Emily Verzola demonstrated that one-year postoperative improvements in hip arthroscopy for femoroacetabular impingement predict superior 10-year outcomes, with lower complications and reoperations, helping guide patient counseling.<br /><br />Dr. Gerhardt discussed the contentious question of “how much arthritis is too much” for preservation. He emphasized individualized decision-making based on arthritis severity, patient age, hip morphology, and expectations. Arthroscopy in mild arthritis yields variable results; greater arthritis often favors arthroplasty. MRI findings, especially subchondral edema, are critical red flags.<br /><br />A debate followed on whether to manage a symptomatic 50-year-old female with hip dysplasia and labral tear with hip preservation (arthroscopy + PAO) or total hip replacement. Dr. Koons advocated for preservation if cartilage was intact and patient active, citing data supporting PAO durability even in older patients. Dr. Gerhardt favored replacement citing faster recovery, advanced implant longevity, and challenges of PAO in older dysplastic hips with arthritis.<br /><br />Audience discussion stressed shared decision-making based on thorough evaluation, staging with arthroscopy to assess cartilage, and careful counseling on risks, benefits, and rehabilitation timelines of each approach.<br /><br />Overall, the session underscored evolving technology and evidence in hip surgery, emphasizing personalized treatment balancing joint preservation and arthroplasty to optimize long-term function and quality of life.

Asset Caption

Moderator: Benjamin G. Domb, M.D.
Shane J. Nho, M.D., M.S. | Emily Berzolla, B.S. | Michael B. Gerhardt, M.D. | Benjamin D. Kuhns, M.D., M.S.

Keywords

hip arthroplasty

hip preservation

borderline hip dysplasia

arthritis management

robotic-assisted surgery

hip resurfacing

hip arthroscopy

periacetabular osteotomy (PAO)

femoroacetabular impingement

shared decision-making

joint preservation vs arthroplasty