Common situations where patients without arthritis might benefit from hip preservation include hip stiffness or pain:

• while getting into or out of a car
• which prevents them from sitting for extended periods at school or work
• when rolling over in bed or that prevents sleep
• when going up or down stairs
• when lying on the side of the hip
• during intercourse

Hip instability, popping in and out, chronic dislocation, and pelvic pain that doesn’t respond to other treatments are other common reasons to turn to hip preservation. For children, the first presentation is often a labral tear that leads to discovering dysplasia, says hip specialist Amy L. Behman, MB ChB, PhD.

Additionally, Behman says, “There’s a lot of evidence coming out that there’s a high risk of hip injury during pregnancy and delivery. If you’re seeing a lot of pain postpartum, that would be a reasonable referral.” Behman also says that any family or personal history of hip dysplasia, any condition that required a brace, or being born breech or as a first-born female are also important risk factors in a patient’s history. 

Patients who develop hip pain during pregnancy or delivery and who do not recover from that pain after the postpartum period should consider being evaluated for hip problems. Pregnant patients who have a family history of hip dysplasia should also consider having their child screened.

Patients and physicians may not recognize hip pain symptoms’ severity initially. “It’s easy for young people to not realize this type of pain is not normal if they’ve had it a long time,” Scott says. “It’s important not to ignore symptoms early on.”

Behman agrees that early treatment is key to hip preservation. “With early treatment, we are able to protect the joint and cartilage to better distribute the forces going across the hip joint. We can minimize or prevent cartilage wear that would lead to hip osteoarthritis,” she says.

For PCPs, a typical flexion, adduction, internal rotation (FADIR) test is the first step to assess hip problems. However, even with tests and imaging, signs of hip impingement may be difficult to identify. “As a hip preservation specialist, I match clinical exam symptoms to signs in imaging that may be very subtle,” says Scott. “Hip conditions can present in a wide spectrum of ways. Even providers who have been trained to recognize hip dysplasia or impingement can miss these signs — it’s very common. If a patient’s radiograph looks normal, but they continue to have pain, even if a provider hasn’t reached a diagnosis, we encourage referrals.”