Hip Preservation Surgery in Sydney

What is hip preservation surgery?

Hip preservation surgery refers to a group of procedures designed to treat certain hip conditions while keeping your own hip joint. Rather than replacing the joint with an implant, these operations aim to correct the underlying structural problem, relieve pain, improve function and, where possible, reduce the likelihood of developing or worsening arthritis.

The hip is a ball-and-socket joint. The rounded head of the thigh bone, or femur, sits within a cup-shaped socket in the pelvis called the acetabulum. Smooth cartilage covers both surfaces, and a rim of soft tissue called the labrum helps to seal and stabilise the joint. When the shape of the bones, the position of the socket or the labrum is abnormal, the joint can be loaded unevenly. Over time this can cause pain and may accelerate cartilage wear.

Hip preservation is often most relevant for younger and more active people. In this group, a joint replacement may wear more quickly and be more likely to need revision surgery later in life. By treating the structural cause earlier, hip preservation aims to protect the natural joint and may help postpone the point at which a replacement is considered.

Hip preservation is an umbrella term rather than a single operation. Depending on your diagnosis, it may involve:

• Hip arthroscopy, keyhole surgery used to reshape areas of impingement and repair or trim the labrum.
• Periacetabular osteotomy (PAO), which repositions the socket to improve cover of the femoral head in hip dysplasia.
• Femoral osteotomy, which reshapes and realigns the upper femur to improve how forces pass through the joint.
• Surgical hip dislocation, an open technique that gives the surgeon direct access to treat complex deformities within the joint.

Do you need hip preservation surgery?

Hip preservation surgery is not required for every case of hip pain. Many hip problems settle with activity modification, physiotherapy, strengthening and time. Surgery is generally considered when a structural cause has been identified, symptoms are ongoing and appropriate non-operative treatment has not provided enough relief.

It is generally most suitable when there is little or no advanced arthritis. The aim is to intervene while the cartilage is still healthy enough to benefit from correcting the underlying problem.

You may be considered for hip preservation surgery if you have:

• Femoroacetabular impingement (FAI), where extra bone on the femoral head or socket rim causes the surfaces to pinch during movement
• Hip dysplasia, where the socket does not adequately cover the femoral head
• A labral tear causing catching, clicking, pain or a feeling of instability
• Selected cartilage or chondral injuries within the joint
• Loose bodies or fragments causing pain and restriction
• Groin or deep hip pain that limits sport, work or daily activity
• Symptoms that continue despite appropriate rehabilitation and activity changes

Assessment usually combines your history, a physical examination and imaging. X-rays can show the shape of the bones, the position of the socket and signs of arthritis. MRI, sometimes with contrast, can assess the labrum and cartilage. CT scanning may be used when a detailed, three-dimensional understanding of the bone shape is needed for planning an osteotomy.

At your consultation, your surgeon will assess whether the problem is structural, whether the cartilage is still in reasonable condition and whether your symptoms match what is seen on imaging. This helps determine whether a joint-preserving approach is appropriate or whether another pathway may serve you better.

Benefits and risks

What the surgery aims to achieve

• Correct the structural cause of hip pain, such as impingement or poor socket cover
• Relieve groin or deep hip pain and improve movement
• Repair or address damage to the labrum and cartilage where possible
• Improve how load passes through the joint
• Support a return to work, exercise or sport after rehabilitation
• Where suitable, reduce the likelihood of developing or worsening arthritis
• Delay or reduce the need for a future hip replacement in appropriately selected patients

Risks to understand

• Common and temporary: pain, swelling, bruising and reduced movement during the early recovery period
• Wound-related: infection, delayed healing, or a scar, which is larger after open osteotomy than after keyhole surgery
• Nerve-related: temporary numbness or altered sensation, which after arthroscopy is often related to traction and commonly settles over the following weeks
• Bone-related (osteotomy): delayed union, non-union or healing in a suboptimal position
• Hardware-related: irritation from screws or plates, or the need for later removal
• Joint-related: stiffness, ongoing pain, incomplete relief of symptoms or progression of cartilage wear
• Procedure-specific: after arthroscopy, rare risks include femoral neck fracture and reduced blood supply to the femoral head
• General: bleeding, blood clots, medication reactions and complications related to anaesthesia or existing medical conditions

Hip preservation procedures have a growing record of relieving symptoms and improving function in appropriately selected patients. They are, however, technically demanding, and results depend heavily on choosing the right procedure for the right hip.

Correcting the structure does not reverse cartilage damage that has already occurred. Where the joint surface is already significantly worn, the benefit may be more limited. Your surgeon will discuss the balance between the expected benefit and the procedure-specific risks in your case.

Hip preservation surgery	Hip replacement surgery
Keeps and repairs your natural joint	Replaces the joint surfaces with an implant
Often considered in younger, more active patients	Often considered when arthritis is more advanced
Most suitable before significant arthritis develops	Suitable for established osteoarthritis
Corrects structural problems such as impingement or dysplasia	Addresses widespread cartilage loss and joint wear
May delay or reduce the likelihood of later replacement	Provides a durable solution for a worn-out joint
Recovery varies widely depending on the procedure	Recovery follows a more established pathway
Longer-term success depends on the remaining cartilage	Implant longevity is a key long-term consideration

The choice is not about which operation is universally better. It is about matching the treatment to the state of the joint and the cause of your symptoms. In some situations, the most appropriate advice may be to continue non-operative treatment for the time being.

The procedure: what happens

Preparing for surgery

Hip preservation surgery is rarely an emergency. Where circumstances allow, preparation before surgery can improve your physical readiness, help you plan for the recovery period and make the early weeks easier to manage.

At MTP Health, preparation may begin several weeks before surgery. Your physiotherapist or exercise physiologist can assess your hip function and provide an individual program focusing on:

• Hip and gluteal strength and control
• Core and pelvic stability
• Movement and flexibility within a comfortable range
• Walking pattern and general conditioning
• Practical strategies for managing everyday activities on crutches

Preparation also means planning the timing of surgery around work, study, family commitments, travel and important events. You may need crutches and have limits on how much weight you can put through the leg during early recovery, so arranging help at home can make a significant difference.

Your surgeon and anaesthetist need an accurate list of all medications, supplements and allergies. Medicines used for blood thinning, diabetes, blood pressure and inflammatory conditions may require specific instructions. Do not stop prescription medication unless your surgeon, anaesthetist or prescribing doctor has told you to do so.

Smoking and nicotine can impair wound and bone healing, which is particularly relevant when an osteotomy needs bone to unite. Stopping as early as possible before surgery and remaining smoke-free during recovery is strongly recommended.

The skin around the hip, groin and upper thigh should remain free from cuts, scratches, bites, rashes or infection. Contact the surgical team if you notice damaged or infected skin, as surgery may need to be delayed to reduce infection risk.

Hospital admission and fasting

The hospital will contact you before surgery to confirm your admission time and individual fasting instructions. Follow the instructions provided by your hospital and anaesthetist, even if they differ from general information you have read elsewhere.

As a general guide, solid food is usually stopped several hours before anaesthesia, while approved clear fluids may be permitted closer to the procedure. Clear fluids commonly include water and certain transparent drinks without milk or solid particles. Milk, cloudy juice and drinks containing pulp are not considered clear fluids.

Before the anaesthetic

You will usually arrive at hospital approximately one to two hours before the planned procedure. A nurse will complete admission checks and prepare the area around the hip. Hair may be clipped where necessary and the skin will be cleaned with an antiseptic solution.

You will meet the anaesthetic team, who will review your health, medications, previous anaesthetic experiences and pain-management plan. Hip preservation procedures are performed under general anaesthesia. If appropriate and you agree, the anaesthetist may also use a regional technique to provide additional pain relief after surgery.

Your surgeon will confirm the operation, hip and side with you and mark the surgical site. The theatre team then performs a formal safety check before the procedure begins, confirming your identity, consent, imaging, planned operation and correct side.

How hip preservation surgery is performed

Because hip preservation covers several different operations, the exact steps depend on your diagnosis and the procedure planned. The following is a general guide to the more common approaches.

Hip arthroscopy. This is keyhole surgery used for conditions such as femoroacetabular impingement, labral tears and loose bodies. The leg is usually positioned so the joint can be gently opened, and two or three small incisions are made around the hip. A thin camera and fine instruments are passed into the joint, allowing the surgeon to reshape areas of impingement, repair or trim the labrum and address cartilage damage. The small incisions are closed at the end of the procedure.

Periacetabular osteotomy (PAO). This open procedure is used mainly for hip dysplasia. A series of controlled cuts is made around the socket so it can be repositioned to better cover the femoral head, then held in the corrected position, commonly with screws. The aim is to spread load more evenly across the joint.

Femoral osteotomy. Here the upper femur is cut and realigned to improve the angle at which it meets the socket, then secured while the bone heals. This can improve how forces pass through the joint and protect the cartilage.

The operating time varies with the procedure, the anatomy and the complexity of the reconstruction. Additional time is needed for anaesthesia, positioning and recovery. Relatives should expect that several hours may pass between leaving the admission area and returning to the ward.

Immediately after surgery

You will wake in the recovery area, where nursing and anaesthetic staff monitor your breathing, circulation, pain and general condition. A regional anaesthetic technique can make the leg feel numb, heavy or weak for several hours.

Once you are medically stable and comfortable, you will return to the ward. Your surgeon will usually contact your nominated relative or support person after the procedure, although this may be several hours after you entered the theatre area.

You will be shown how to move safely and how to use your crutches within the weight-bearing limits set for your procedure. After keyhole surgery, many people go home the same day or after one night. After an osteotomy, a longer stay of a few nights is common.

Dressings and wound care

Your dressing is usually water-resistant but should not be treated as completely waterproof. Keep the dressing clean, dry and intact until your first follow-up appointment unless the surgical team gives you different instructions.

A small amount of staining beneath the dressing can be normal. Contact the team if the dressing becomes saturated, the wound begins leaking persistently or you develop increasing redness, swelling, heat, fever or worsening pain.

Avoid soaking the wound in a bath, pool, spa or ocean until it is fully healed and your surgeon has confirmed that immersion is safe.

Weight-bearing and crutches

Crutches are used after most hip preservation procedures, but for very different lengths of time. After hip arthroscopy, crutches are often needed for a short period, mainly for comfort and to protect the joint while it settles. After an osteotomy, a longer period of protected or partial weight-bearing is usual while the bone heals.

Follow the specific weight-bearing instructions given for your procedure rather than progressing on how the hip feels. Putting too much load through the joint too early can affect healing.

Hip preservation recovery and rehabilitation

Recovery begins as soon as you wake from the anaesthetic, but the early priority is protection rather than pushing movement. The joint, and in the case of an osteotomy the healing bone, need time to settle before load and strengthening are increased.

Your rehabilitation program will be tailored to your operation, imaging, symptoms and progress. Timelines differ considerably between a keyhole arthroscopy and a bone-realigning osteotomy. Follow the protocol provided by your surgeon and rehabilitation team rather than progressing exercises independently.

Recovery timeline

Phase	Timeframe	What to expect
Protect and settle	Days 0–14	Wound care, pain control, crutches and the weight-bearing limits set for your procedure, plus gentle approved movement
Early rehabilitation	Weeks 2–6	Guided range-of-motion work and gradual progress with crutches where permitted, supervised by your physiotherapist
Restore movement	Weeks 6–12	Weaning off crutches where appropriate, rebuilding your walking pattern and restoring everyday hip movement
Build strength	Months 3–4	Progressive hip, gluteal and core strengthening once healing is satisfactory
Return to activity	Months 4–6	Graded return to gym, work conditioning and low-impact activity where strength and movement allow
Return to demanding activity	From approximately 6 months	Higher-impact or sport-specific activity after clinical review; some procedures, particularly osteotomy, may take longer

These timeframes are a guide only. The procedure performed, bone healing, cartilage condition, symptoms, imaging findings and activity demands can all change the schedule.

The first six weeks

The early weeks focus on protecting the joint, controlling pain and swelling and beginning gentle movement within your surgeon's limits. Deep squatting, pivoting and forcing the hip into painful positions are generally avoided during this period.

You will usually be given specific weight-bearing instructions for your crutches. Some procedures allow you to place a limited amount of weight through the leg early, while others require a longer protected period. Do not compare your program with another patient's recovery, as the underlying operation may be very different.

Gentle, approved exercises help maintain circulation and prevent stiffness. Your physiotherapist will guide which movements are safe and when to progress them.

Sleeping and resting

Sleeping can be uncomfortable during the early recovery period. Many people find it easier to sleep on their back, sometimes with a pillow supporting the leg. Lying on the operated side may not be comfortable for some weeks.

Follow any positioning advice your surgeon or physiotherapist provides, particularly after an osteotomy.

Weeks six to twelve

Once your surgeon is satisfied with the early healing, you may begin weaning off crutches where appropriate and progressing your hip movement. Rehabilitation focuses on restoring a normal walking pattern and everyday function without overloading the joint.

You should not force through sharp pain. The goal is steady, progressive improvement rather than recovering every degree of movement as quickly as possible.

From approximately three months

Progressive strengthening commonly builds through this phase, subject to clinical and, where relevant, imaging review. Early strengthening focuses on control and endurance before heavier resistance and higher-impact activity are introduced.

Your program may include:

• Hip and gluteal strengthening
• Core and pelvic control
• Balance and single-leg control
• Graded walking and, in time, low-impact cardio
• Functional and work-specific movements
• Sport-specific preparation where appropriate

Strength, movement and confidence continue to improve well beyond the point when you first feel better. Recovery is commonly measured over several months, and demanding activity is reintroduced gradually.

Rehabilitation at MTP Health

This is where MTP Health is different. Your rehabilitation can be delivered by physiotherapists and exercise physiologists working in the same clinical environment as your surgeon. Your program can begin before surgery and continue through the protective, movement, strengthening and return-to-activity stages.

Rehabilitation is not simply a list of hip exercises. It involves monitoring pain and movement, protecting the joint or healing bone, rebuilding strength and preparing you for the specific physical demands of your life.

Your recovery may be supported by our pre-operative rehabilitation, post-operative rehabilitation, physiotherapy and exercise physiology services.

Returning to driving, work and sport

Driving

You should not drive while you still need crutches or while your ability to control the vehicle is affected. Driving should also wait until you are no longer taking medication that affects alertness, judgement or reaction time.

Before returning to driving, you must be able to operate all controls, perform an emergency stop and move safely in and out of the vehicle. Your surgeon will advise when this is appropriate based on your procedure, side of surgery and recovery.

There is no single timeframe that applies to every patient. Check with your surgeon and insurer before driving, particularly if you drive a manual vehicle or drive professionally.

Office-based work

Computer-based or administrative work may be possible relatively early after keyhole surgery if pain is controlled, you are no longer taking strong pain medication and you can manage the commute. After an osteotomy, more time is usually needed.

Prolonged sitting can be uncomfortable early on. A staged return, shorter days, regular position changes or working from home may make the transition easier.

Physical work

Work involving standing, walking, lifting, climbing or uneven ground requires substantially more recovery time. Returning to heavy manual work commonly requires a structured conditioning program and may take several months, particularly after a bone procedure.

Gym and general exercise

Light, approved exercise is often reintroduced gradually as movement and strength allow. Higher-impact activities such as running are typically reintroduced later and only once strength, control and healing are satisfactory.

Sport

Return to sport depends heavily on the procedure and the sport. After hip arthroscopy for impingement or a labral tear, a graded return to sport is often possible within several months. After an osteotomy, the timeline is usually longer because the bone must heal fully first.

Returning to sport is based on your examination, imaging where relevant, rehabilitation progress and the physical demands of the activity, rather than a fixed date.

Follow-up after hip preservation surgery

Your first post-operative appointment is usually held within the first couple of weeks. This visit is important for checking the wound, reviewing pain and medication, confirming the rehabilitation plan and answering questions about the early recovery.

Further appointments may include:

• A review in the early weeks, sometimes with an X-ray after a bone procedure
• A review at around three months to assess healing and progress
• A review at around six months, particularly before returning to demanding work or sport

Imaging may be used to assess healing after an osteotomy. Your follow-up schedule will depend on your procedure, your surgeon's protocol and how your recovery is progressing.

What outcomes can you expect?

Hip preservation surgery can relieve pain and improve function for many appropriately selected patients, and in suitable cases may help protect the joint over the longer term. Many people are able to return to active lifestyles and, depending on the procedure, to sport.

The surgery cannot reverse cartilage damage that has already occurred, and it cannot guarantee that arthritis will never develop or that a hip replacement will never be needed. Where wear is already advanced at the time of surgery, the benefit may be more limited.

Outcomes vary between individuals and between procedures. The condition being treated, the amount of existing cartilage wear, the accuracy of the correction and how well the rehabilitation is completed all influence the result.

The best outcomes generally come from selecting the right patient and procedure, correcting the underlying structural problem accurately, protecting the joint during early healing and completing a structured rehabilitation program.

Hip preservation surgery cost in Sydney

The cost of hip preservation surgery depends on the procedure performed, your private health cover, hospital policy, surgeon fee, anaesthetist fee, assistant fee, imaging, rehabilitation needs and any excess or co-payment attached to your insurance policy.

Before surgery, MTP Health provides written information about the surgeon's fee and informed financial consent. The anaesthetist and hospital are separate providers and may charge additional fees, so their costs should be confirmed directly.

Potential costs can include:

• Surgeon and surgical assistant fees
• Anaesthetist fees
• Hospital excess or co-payment
• Imaging and pathology
• Post-operative medication
• Crutches, equipment or aids
• Physiotherapy and exercise physiology

Health fund rebates and out-of-pocket costs vary considerably. A GP referral is generally required so that Medicare can contribute to part of the cost of your specialist consultation. Before committing to surgery, ask your surgeon, hospital, anaesthetist and health insurer for an itemised estimate based on your policy and planned procedure.

Why have your hip preservation surgery at MTP Health?

MTP Health brings together orthopaedic surgery, physiotherapy and exercise physiology within one clinical team. This matters because hip preservation is not only about the operation. It involves choosing the right procedure, preparing well, protecting the joint and progressing safely back to work or sport.

Honest advice comes first. If your hip is likely to improve without surgery, we will explain the non-operative options. If your imaging suggests that a joint-preserving procedure is unlikely to help, we will explain why and discuss the alternatives. If hip preservation is appropriate, you will be given a clear explanation of the expected benefit, recovery and risks.

Your rehabilitation can begin before surgery and continue afterwards with a team that understands the procedure performed and the activities you need to return to.

Your surgeon

Frequently asked questions