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Why Our Team Includes Both Open and Arthroscopic Surgeons
A Collaborative Approach to Comprehensive Hip Preservation
Hip preservation is not defined by a single procedure or technique—it is defined by understanding why a hip is failing and selecting the right solution to address both symptoms and structure. While some hip problems can be treated arthroscopically, others require open reconstruction to correct underlying alignment and stability issues. In many cases, effective treatment requires both approaches working together.
A comprehensive hip preservation model brings together surgeons with deep expertise in arthroscopic techniques and surgeons trained in complex open reconstruction. This collaborative approach allows soft tissue injury and structural deformity to be addressed as part of a unified strategy, rather than in isolation. By aligning surgical skillsets around the true source of a patient’s symptoms, the goal is not simply short-term pain relief—but durable joint preservation and long-term function.
Why Hip Preservation Requires More Than One Skillset
Hip pain can arise from a wide range of underlying problems. In some patients, symptoms are driven primarily by soft tissue injury—such as labral tears or cartilage damage—while in others, the root cause lies in the structure of the hip itself. These structural issues may include inadequate socket coverage, abnormal bone shape, or instability that alters how forces are distributed across the joint.
Because of this complexity, hip preservation is not a one-size-fits-all specialty. No single procedure can address every contributor to hip dysfunction, and no single surgical approach is appropriate for all patients. Treating only what is visible on imaging—without correcting the mechanics that created the problem—can lead to incomplete or short-lived results.
Arthroscopic techniques are highly effective for addressing damage within the joint, particularly when performed by surgeons with deep, high-volume experience. Open reconstructive procedures, on the other hand, are required when the underlying issue is structural and must be corrected at the level of bone alignment and joint stability.
A comprehensive hip preservation strategy recognizes these distinctions and brings multiple skillsets together. By combining expertise in arthroscopy and open reconstruction, care can be tailored to the specific problem driving each patient’s symptoms—rather than forcing every hip into a single treatment pathway.
The Role of Hip Arthroscopy in Hip Preservation
Hip arthroscopy plays a critical role in modern hip preservation by allowing surgeons to directly visualize and treat damage inside the joint through minimally invasive techniques. This includes repairing labral tears, addressing cartilage injury, and reshaping abnormal bone associated with femoroacetabular impingement (FAI).
While arthroscopy is less invasive than open surgery, it is technically demanding and requires a high level of specialization. The hip joint is deep, constrained, and unforgiving; small variations in technique can have significant consequences for outcomes. For this reason, experience matters. Surgeons who perform hip arthroscopy at a high volume develop the skill and judgment necessary to navigate complex anatomy, protect surrounding structures, and address pathology comprehensively.
In many patients—particularly athletes and active individuals—arthroscopy can effectively relieve pain, restore function, and prevent further damage when the underlying problem is limited to soft tissue injury or focal impingement. When used appropriately, it is a powerful joint-preserving tool.
However, hip arthroscopy alone cannot correct problems of alignment, coverage, or stability. When structural abnormalities are present, treating the soft tissue without addressing the underlying mechanics may leave the joint vulnerable to ongoing stress and recurrent injury. Recognizing these limitations is essential to selecting the right treatment strategy.
For this reason, hip arthroscopy is most effective when it is part of a broader preservation framework—one that integrates structural assessment and, when necessary, open reconstructive techniques to address the root cause of hip dysfunction.
When Structural Correction Is Necessary
Not all hip pain originates from damage inside the joint. In some patients, symptoms are driven by structural abnormalities that affect how the hip functions under load. These issues cannot be corrected arthroscopically because they involve the shape, orientation, or stability of the joint itself.
Structural hip problems include conditions such as hip dysplasia, instability, abnormal femoral rotation, or deformities that alter joint mechanics. In these cases, the hip socket may not adequately support the femoral head, or forces may be distributed unevenly across the joint with everyday activity. Over time, this abnormal loading can lead to labral tears, cartilage damage, and progressive joint degeneration.
Open reconstructive procedures—such as periacetabular osteotomy (PAO) or femoral osteotomy—are designed to correct these underlying issues by restoring proper alignment, coverage, and stability. Unlike arthroscopy, which addresses the consequences of abnormal mechanics, these procedures correct the root cause of joint overload.
Because these surgeries involve precise bone cuts and realignment, they require specialized training and experience. When performed appropriately, structural correction can dramatically change the trajectory of hip health—reducing pain, improving function, and preserving the natural joint for the long term.
Understanding when structural correction is necessary is a critical step in hip preservation. Treating soft tissue damage without addressing underlying instability or malalignment may provide temporary relief, but durable outcomes depend on restoring proper joint mechanics.
Why Some Patients Need a Combined Approach
“Durable hip preservation often requires addressing both damage and mechanics.”
In certain hips, pain and dysfunction are not caused by a single issue. Instead, they result from a combination of soft tissue damage and structural instability that must be addressed together to achieve durable results.
Hip arthroscopy is highly effective at treating labral tears, cartilage injury, and impingement inside the joint. However, when those injuries are caused by underlying problems such as hip dysplasia, abnormal version, or instability, repairing the damaged tissue alone may not be enough. Without correcting the mechanics of the joint, abnormal forces can persist—placing repaired structures back under stress.
In these cases, a combined approach allows both components of the problem to be treated as part of a unified plan. Arthroscopy addresses the damage that has already occurred, while open reconstruction corrects the alignment or coverage issues that led to injury in the first place. When coordinated properly, these procedures work together to restore more normal joint mechanics and protect the hip long term.
For some patients, these procedures are performed during the same surgical setting. For others, they may be carefully staged. The decision depends on anatomy, symptoms, imaging findings, and overall hip stability. What matters most is not timing alone, but thoughtful coordination between surgeons who understand both aspects of hip preservation.
A combined approach is not about doing more surgery—it is about doing the right surgery, in the right sequence, to address the true source of symptoms. By integrating arthroscopic and open expertise, care can be individualized rather than forced into a single treatment pathway.
The Value of a Team-Based Surgical Model
Because hip preservation often requires both arthroscopic and open techniques, the quality of care depends not only on individual skill—but on collaboration. A team-based surgical model brings together surgeons with complementary expertise, allowing each aspect of a complex hip problem to be addressed by the specialist best suited for that task.
High-volume hip arthroscopy requires a different skill set than complex open reconstruction. Surgeons who focus on arthroscopy develop deep expertise in treating labral tears, cartilage injury, and femoroacetabular impingement using minimally invasive techniques. Others are trained specifically in structural correction—procedures such as periacetabular osteotomy (PAO) or femoral osteotomy that realign the hip to restore stability and mechanics.
In a collaborative model, these perspectives are integrated from the start. Imaging is reviewed collectively, surgical plans are discussed as a group, and decisions are made with both soft tissue and structural considerations in mind. This reduces the risk of treating one part of the problem while overlooking another.
For patients who require combined treatment, collaboration becomes even more important. Coordinating arthroscopy and structural correction—whether performed together or in a staged manner—requires precise planning and shared understanding between surgeons. When care is fragmented, important details can be missed. When care is coordinated, treatment is more deliberate, individualized, and durable.
This team-based approach is not about involving more surgeons—it is about involving the right expertise at the right time. By aligning arthroscopic and open reconstruction specialists around a single treatment strategy, hip preservation care becomes more comprehensive and better suited to the complexity of each patient’s anatomy and goals.
Why an Integrated Hip Preservation Team Matters
The Difference Between Fragmented Care and Comprehensive Hip Preservation
Hip preservation is rarely a one-size-fits-all solution. Many patients have both soft tissue damage and underlying structural problems, and long-term success depends on addressing all contributors—not just the most obvious one.
When care is fragmented—where arthroscopy and osteotomy are treated as separate decisions or handled by different teams—important details can be missed. This can lead to incomplete treatment, persistent symptoms, or the need for additional surgery later.
At Hip Preservation, every case is evaluated collaboratively by surgeons experienced in both arthroscopic and open hip procedures. This integrated approach allows the team to:
Identify whether symptoms stem from soft tissue injury, structural alignment, or both
Determine when a single procedure is sufficient—and when a combined approach offers better durability
Plan surgery with the end goal in mind: long-term joint preservation, not short-term symptom relief
One Evaluation. One Plan. The Right Surgery.
Rather than asking, “Can this be treated arthroscopically?” the focus is on a more important question:
“What combination of treatments gives this patient the best long-term outcome?”
Because Hip Preservation surgeons routinely perform:
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Combined procedures when appropriate
…patients benefit from objective decision-making, not procedural bias.
What This Means for Patients
For patients, an integrated team approach means:
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Fewer unnecessary procedures
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Clear explanations of why a certain approach is recommended
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Reduced risk of under-treatment or repeat surgery
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Confidence that structural and soft tissue issues are addressed together
This level of coordination is especially important for:
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Young and athletic patients
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Patients with borderline dysplasia or complex anatomy
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Those who have had prior hip surgery but still have symptoms
The Goal Is Not More Surgery — It’s the Right Surgery
Hip preservation succeeds when the true source of pain and instability is identified and corrected. Sometimes that means arthroscopy alone. Sometimes it means an osteotomy. And in some cases, it means combining both—intentionally, in the same surgical plan.
An integrated hip preservation team ensures that the solution is tailored to the patient—not limited by the tools of a single specialty.
Comprehensive Hip Preservation Starts With the Right Team
Choosing the right approach to hip preservation starts with understanding the full picture—soft tissue health, joint mechanics, and long-term stability. A collaborative surgical model ensures that each patient’s anatomy and goals drive the treatment plan, not the limitations of a single technique.
