Hip Replacement Alternatives: Joint-Preserving & Non-Surgical Options

Total hip arthroplasty (THA) is highly successful, but not the only path. Alternatives depend on age, activity, pathology, and patient goals.

Joint-Preserving Surgical Options

Procedure	Indication	Key Points
Hip Resurfacing (BHR, etc.)	Young (<60), active males; good bone stock; large femoral head; primary OA	Preserves femoral neck/head; metal-on-metal bearing (ion monitoring needed); easier revision to THA; higher fracture risk early.
Periacetabular Osteotomy (PAO / Ganz)	Young adults with acetabular dysplasia (LCEA <20°); minimal arthritis	Reorients acetabulum; preserves joint; 10-yr survivorship >85%; complex, specialized centers only.
Femoral Osteotomy	Varus/valgus malunion, coxa vara, developmental deformity	Realignment to offload damaged cartilage; niche indication.
Hip Arthroscopy	Labral tear, FAI (cam/pincer), loose bodies, early chondral damage (Outerbridge I–II)	Minimally invasive; labral repair, cam resection, microfracture. Not for advanced OA (Kellgren-Lawrence ≥3). Outcomes decline with age >40–45, Tönnis grade >1.
Core Decompression ± Biologics	Early AVN (Ficat I–II); small lesion	Drills necrotic focus; adds BMAC, PRP, synthetic graft. Success drops sharply with collapse.

Non-Surgical Management (First-Line for Most)

• Physical Therapy: Core/glute strengthening, gait retraining, manual therapy, modalities. 12-week trial standard.
• Weight Loss: Each 1 lb loss = 3–6 lb less joint load. BMI <25 ideal.
• Activity Modification: Low-impact (swim, cycle, elliptical); avoid deep flexion, impact.
• Oral Analgesia: Acetaminophen first-line; NSAIDs (topical preferred for GI/CV risk); duloxetine for chronic pain.
• Intra-articular Injections:
  • Corticosteroid: 3–4 month relief; limit 3–4/year (chondrotoxicity concern).
  • Hyaluronic Acid (Viscosupplementation): Modest benefit, 6-month duration; insurance variable.
  • PRP / BMAC: Emerging evidence; not standard; out-of-pocket.
• Assistive Devices: Cane (contralateral), walker, shoe lift for LLD.

Decision Framework

1. Exhaust non-surgical (3–6 months).
2. If failed & symptoms limit QOL → imaging + surgeon eval.
3. Age <50, high demand, preserved joint → consider preservation (PAO, arthroscopy, resurfacing).
4. Age >60, advanced OA, low demand → THA (gold standard).
5. Age 50–60, moderate demand → shared decision: THA vs. preservation (survivorship vs. revision risk).

The best alternative is the one matched to your anatomy, lifestyle, and values—decided in partnership with a hip preservation specialist and arthroplasty surgeon.